Manuella D Khoshaba

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

013818 Issued in AZ

Practice address

7201 W Camino San Xavier
Glendale, AZ 85308-3798

Phone

(623) 703-2748

NPI assigned

Apr 10, 2019

Last updated

Feb 3, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1554854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612310400000",
    "number": "1396208955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7201 W CAMINO SAN XAVIER",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853083798",
            "telephone_number": "623-703-2748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7201 W CAMINO SAN XAVIER",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853083798",
            "telephone_number": "623-703-2748"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13821 W Crocus Dr",
            "address_purpose": "LOCATION",
            "city": "Surprise",
            "state": "AZ",
            "postal_code": "853798340",
            "country_code": "US",
            "telephone_number": "623-703-2748",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHOSHABA",
        "first_name": "MANUELLA",
        "middle_name": "D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-04-10",
        "last_updated": "2021-02-03",
        "certification_date": "2021-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AZ",
            "license": "013818",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mk834@nau.edu",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "13821 W Crocus Dr",
            "city": "Surprise",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "853798340",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Skilled Nursing Facility in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Skilled Nursing Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2021; 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.