Haris Basri Sinaga

Primary specialty

Licensed Vocational NurseTaxonomy code 164X00000X

License

VN214075 Issued in CA

Practice address

14677 Merrill Avenue
Fonta, CA 92335

Phone

(951) 643-2340

NPI assigned

Oct 25, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Alondra Loya

  • Case Manager/Care Coordinator
  • Fontana, CA
  • NPI 1568160828
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1571961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571961600000",
    "number": "1356984082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12440 TAMARISK DR",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917391517",
            "telephone_number": "909-972-5349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14677 MERRILL AVENUE",
            "city": "FONTA",
            "state": "CA",
            "postal_code": "92335",
            "telephone_number": "951-643-2340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SINAGA",
        "first_name": "HARIS",
        "middle_name": "BASRI",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-10-25",
        "last_updated": "2019-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "VN214075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.