Active NPI
Jeanette Ann Prince
- Specialist
- Lancaster, CA
National Provider Identifier
1407518269
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- L9516
- Practice address
- 830 W Avenue L Ste 109
Lancaster, CA 93534-7207 - Phone
- (661) 902-1793
- NPI assigned
- Oct 8, 2021
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | L9516 | CA | Primary |
Addresses
Primary practice location
830 W Avenue L Ste 109
Lancaster, CA 93534-7207
Mailing address
1741 Landsford St
Lancaster, CA 93535-1150
Phone (661) 917-5322
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 |
|---|---|---|---|
| L9516 | CA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1633651200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1633651200000",
"number": "1407518269",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1741 LANDSFORD ST",
"city": "LANCASTER",
"state": "CA",
"postal_code": "935351150",
"telephone_number": "661-917-5322"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "830 W AVENUE L STE 109",
"city": "LANCASTER",
"state": "CA",
"postal_code": "935347207",
"telephone_number": "661-902-1793"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRINCE",
"first_name": "JEANETTE",
"middle_name": "ANN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-10-08",
"last_updated": "2021-10-08",
"certification_date": "2021-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CA",
"license": "L9516",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lancaster, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 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.