Active NPI
Elisa Victoria Jiang, REGISTERED OTR
- Occupational Therapist
- Tustin, CA
National Provider Identifier
1376012625
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 404862
- Practice address
- 17842 Irvine Blvd Ste 118
Tustin, CA 92780-3243 - Phone
- (949) 903-8229
- NPI assigned
- Nov 15, 2018
- 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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 404862 | CA | Primary |
Addresses
Primary practice location
17842 Irvine Blvd Ste 118
Tustin, CA 92780-3243
Mailing address
17842 Irvine Blvd Ste 118
Tustin, CA 92780-3243
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 404862 | Other | CERTIFICATION NUMBER |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 404862 | CA | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Zenith Speech Therapy Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Speech-Language Pathologist
- Irvine, CA
- NPI 1851841191
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1542240000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1542240000000",
"number": "1376012625",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17842 IRVINE BLVD STE 118",
"city": "TUSTIN",
"state": "CA",
"postal_code": "927803243"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17842 IRVINE BLVD STE 118",
"city": "TUSTIN",
"state": "CA",
"postal_code": "927803243",
"telephone_number": "949-903-8229"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JIANG",
"first_name": "ELISA",
"middle_name": "VICTORIA",
"name_prefix": "Mrs.",
"credential": "REGISTERED OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-11-15",
"last_updated": "2018-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CA",
"license": "404862",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CERTIFICATION NUMBER",
"identifier": "404862",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Tustin, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.