Edgar Ontiveros

Primary specialty

Case Management AgencyTaxonomy code 251B00000X

Legal business name

EDGAR ONTIVEROS

Practice address

15204 Lakeshore Dr
Clearlake, CA 95422-8107

Phone

(170) 726-3433

Fax

(170) 726-3433

NPI assigned

Jul 27, 2011

Organization subpart

No

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

Authorized official

Name

Mr. Edgar Rincon Ontiveros Sr.

Title

Case Manager Hispanic Outreach

Phone

(707) 263-4338

Specialties & licenses 1

Addresses

Other names 1

• Mental Health Former legal business name

Locations

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

{
    "created_epoch": "1311724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311724800000",
    "number": "1376821108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15204 LAKESHORE DR",
            "city": "CLEARLAKE",
            "state": "CA",
            "postal_code": "954228107",
            "telephone_number": "170-726-3433",
            "fax_number": "170-726-3433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15204 LAKESHORE DR",
            "city": "CLEARLAKE",
            "state": "CA",
            "postal_code": "954228107",
            "telephone_number": "170-726-3433",
            "fax_number": "170-726-3433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGAR ONTIVEROS",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-27",
        "last_updated": "2011-07-27",
        "status": "A",
        "authorized_official_last_name": "ONTIVEROS",
        "authorized_official_first_name": "EDGAR",
        "authorized_official_middle_name": "RINCON",
        "authorized_official_title_or_position": "CASE MANAGER HISPANIC OUTREACH",
        "authorized_official_telephone_number": "17072634338",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mental Health",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Jerry Edward Douglas, MD
• Clay Drinnon
• Gale Lanette Dunham, PHARM. D.
• Kelly Dymer, RN
• Christina Dytche
• Janet M Edmonds, COUNSELOR CAS, RAS
• Malka Rhonda Eisgrau, LPC, LPN
• Peter Monroe Eliot
• Jack M Elizares, O.D.
• Tia Ellis

• Case Management Agency in Clearlake, CA
• Providers in Clearlake, CA by specialty
• Case Management Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2011; 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.