Active NPI
Graciela Perez Ponce
- Recreation Therapist
- Lynwood, CA
National Provider Identifier
1417437831
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Recreation Therapist
- Practice address
- 3820 Martin Luther King Jr Blvd
Lynwood, CA 90262-3625 - Phone
- (310) 632-0421
- NPI assigned
- Aug 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 |
|---|---|---|---|---|
| Recreation Therapist | 225800000X | Primary |
Addresses
Primary practice location
3820 Martin Luther King Jr Blvd
Lynwood, CA 90262-3625
Mailing address
1567 E 22ND St
Los Angeles, CA 90011-1350
Phone (323) 836-4566
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1534291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1534291200000",
"number": "1417437831",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1567 E 22ND ST",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900111350",
"telephone_number": "323-836-4566"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3820 MARTIN LUTHER KING JR BLVD",
"city": "LYNWOOD",
"state": "CA",
"postal_code": "902623625",
"telephone_number": "310-632-0421"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEREZ PONCE",
"first_name": "GRACIELA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-08-15",
"last_updated": "2018-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "225800000X",
"taxonomy_group": "",
"desc": "Recreation Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lynwood, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 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.