Individual provider Active NPI

Liza Macatula

  • Registered Nurse
  • San Diego, CA
National Provider Identifier
1417494014
Registry record updated Jan 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
492782 Issued in CA
Practice address
5530 Overland Ave
San Diego, CA 92123-1260
Phone
(858) 974-5960
NPI assigned
Jan 21, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 21, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 492782 CA Primary
Nurse Practitioner 363L00000X 13154 CA

Addresses

Primary practice location

5530 Overland Ave
San Diego, CA 92123-1260

Mailing address

17386 Tablero PL
San Diego, CA 92127-1313
Phone (858) 613-1474

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

LicenseStateTypeSpecialty
492782CAMDRegistered Nurse
13154CAMDNurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1484956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484956800000",
    "number": "1417494014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17386 TABLERO PL",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921271313",
            "telephone_number": "858-613-1474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5530 OVERLAND AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921231260",
            "telephone_number": "858-974-5960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACATULA",
        "first_name": "LIZA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-01-21",
        "last_updated": "2017-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "492782",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "13154",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2017; 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.