Active NPI
Mary Jo Gustin, D.C.
- Rehabilitation Chiropractor
- Los Angeles, CA
National Provider Identifier
1447365655
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Chiropractor
- License
- 17484
- Practice address
- 11710 Wilshire Blvd
Los Angeles, CA 90025-1503 - Phone
- (310) 873-4422
- Fax
- (310) 873-4434
- NPI assigned
- Aug 20, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 263-0796 | NH | |
| Rehabilitation Chiropractor | 111NR0400X | 17484 | CA | Primary |
Addresses
Primary practice location
11710 Wilshire Blvd
Los Angeles, CA 90025-1503
Mailing address
11710 Wilshire Blvd
Los Angeles, CA 90025-1503
Phone (310) 873-4422
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30251443 | Medicaid | NH |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 263-0796 | NH | MD | Chiropractor |
| 17484 | CA | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156032000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1441238400000",
"number": "1447365655",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11710 WILSHIRE BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900251503",
"telephone_number": "310-873-4422",
"fax_number": "310-873-4434"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11710 WILSHIRE BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900251503",
"telephone_number": "310-873-4422",
"fax_number": "310-873-4434"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUSTIN",
"first_name": "MARY",
"middle_name": "JO",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-20",
"last_updated": "2015-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "NH",
"license": "263-0796",
"primary": false
},
{
"code": "111NR0400X",
"taxonomy_group": "",
"desc": "Chiropractor, Rehabilitation",
"state": "CA",
"license": "17484",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30251443",
"state": "NH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.