Active NPI
Cava Genevieve Hadikusumo, PHARM.D.
- Pharmacist
- Fontana, CA
National Provider Identifier
1437222866
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH 57282
- Practice address
- 9310 Sierra Ave
Fontana, CA 92335-5711 - Phone
- (909) 427-3838
- Fax
- (909) 427-3830
- NPI assigned
- Nov 15, 2006
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH 57282 | CA | Primary |
Addresses
Primary practice location
9310 Sierra Ave
Fontana, CA 92335-5711
Mailing address
9310 Sierra Ave
Fontana, CA 92335-5711
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH 57282 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1437222866",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9310 SIERRA AVE",
"city": "FONTANA",
"state": "CA",
"postal_code": "923355711"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9310 SIERRA AVE",
"city": "FONTANA",
"state": "CA",
"postal_code": "923355711",
"telephone_number": "909-427-3838",
"fax_number": "909-427-3830"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HADIKUSUMO",
"first_name": "CAVA",
"middle_name": "GENEVIEVE",
"credential": "PHARM.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "RPH 57282",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fontana, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.