San Jose Integrated Clinic LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

SAN JOSE INTEGRATED CLINIC LLC

Practice address

2000 E Juan Sanchez Blvd
San Luis, AZ 85336-0481

Phone

(928) 722-6098

Fax

(928) 627-0007

NPI assigned

Oct 17, 2019

Last updated

Oct 17, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Clarisse Vanessa Nguehanana, FNPNPI 1356894240

Title

Ceo

Phone

(928) 722-6098

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Clarisse Vanessa Ngueha-Nana

  • Family Nurse Practitioner
  • San Luis, AZ
  • NPI 1356894240
  Medicare reassignment NPD Authorized official
• Lisa Ling, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Green Valley, AZ
  • NPI 1801299078

  Family

  Medicare reassignment NPD
• Ray Silao, M.D.

  • Internal Medicine Physician
  • Yuma, AZ
  • NPI 1831217504
  NPD (past)
• Mary Susan Buffington, NP-C

  • Family Nurse Practitioner
  • Winterhaven, CA
  • NPI 1699858472
  NPD (past)
• John Nicholas Gietzen, D.O.

  • Family Medicine Physician
  • New Glarus, WI
  • NPI 1538178025
  NPD (past)
• Cecilia Gonzalez Ruiz, PA-C

  • Physician Assistant
  • Santee, CA
  • NPI 1558335414
  NPD (past)

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

{
    "created_epoch": "1571270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571270400000",
    "number": "1386287753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2575 W 24TH ST APT 168",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853646066",
            "telephone_number": "928-722-6098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 E JUAN SANCHEZ BLVD",
            "city": "SAN LUIS",
            "state": "AZ",
            "postal_code": "853360481",
            "telephone_number": "928-722-6098",
            "fax_number": "928-627-0007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN JOSE INTEGRATED CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-17",
        "last_updated": "2019-10-17",
        "status": "A",
        "authorized_official_last_name": "NGUEHANANA",
        "authorized_official_first_name": "CLARISSE",
        "authorized_official_middle_name": "VANESSA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "928-722-6098",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leonardo Rodriguez, M.D.
• Ava Rose, M.D.
• Todd K Runyan, M.D.
• Manuel Angel Salcido, D.D.S.
• San Jose Health Clinic, LLC
• San Luis Walk-in Clinic, Inc. (San Luis Urgent Care)
• San Luis Walk-in Clinic, Inc.
• San Luis Walk-in Clinic, Inc. (San Luis Outpatient Surgery Center)
• San Luis Walk-in Clinic, Inc. (San Luis Urgent Care)
• San Luis Walk-in Clinic, Inc.

• Family Nurse Practitioner in San Luis, AZ
• Providers in San Luis, AZ by specialty
• Family Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.