Active NPI
Jennifer Putney, RDA
- Dental Assistant
- Hemet, CA
National Provider Identifier
1417492935
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Assistant
- License
- RDA73563
- Practice address
- 5814 Nectar Ave
Hemet, CA 92544-4552 - Phone
- (951) 426-3534
- NPI assigned
- Dec 20, 2016
- 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 |
|---|---|---|---|---|
| Dental Assistant | 126800000X | RDA73563 | CA | Primary |
Addresses
Primary practice location
5814 Nectar Ave
Hemet, CA 92544-4552
Mailing address
5814 Nectar Ave
Hemet, CA 92544-4552
Phone (951) 426-3534
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RDA73563 | Medicaid | CA |
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 |
|---|---|---|---|
| RDA73563 | CA | MD | Dental Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1482192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1482192000000",
"number": "1417492935",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5814 NECTAR AVE",
"city": "HEMET",
"state": "CA",
"postal_code": "925444552",
"telephone_number": "951-426-3534"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5814 NECTAR AVE",
"city": "HEMET",
"state": "CA",
"postal_code": "925444552",
"telephone_number": "951-426-3534"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUTNEY",
"first_name": "JENNIFER",
"name_prefix": "Miss",
"credential": "RDA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-12-20",
"last_updated": "2016-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "126800000X",
"taxonomy_group": "",
"desc": "Dental Assistant",
"state": "CA",
"license": "RDA73563",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "RDA73563",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hemet, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.