Active NPI
Jessica Sofie Liutkus, ATC
- Athletic Trainer
- San Diego, CA
National Provider Identifier
1306369715
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 13010 Paseo Lucido
San Diego, CA 92128-4478 - Phone
- (858) 485-4800
- NPI assigned
- Jul 18, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | Primary |
Addresses
Primary practice location
13010 Paseo Lucido
San Diego, CA 92128-4478
Mailing address
16543 S Catawba Rd
Homer Glen, IL 60491-9633
Phone (773) 865-6343
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1500336000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1500336000000",
"number": "1306369715",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16543 S CATAWBA RD",
"city": "HOMER GLEN",
"state": "IL",
"postal_code": "604919633",
"telephone_number": "773-865-6343"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13010 PASEO LUCIDO",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921284478",
"telephone_number": "858-485-4800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIUTKUS",
"first_name": "JESSICA",
"middle_name": "SOFIE",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-07-18",
"last_updated": "2017-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.