Individual provider Active NPI

Fernand Bamba Taruc

  • Gerontology Nurse Practitioner
  • Glendale, CA
National Provider Identifier
1457557779
Registry record updated Apr 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
95012147 Issued in CA
Practice address
3857 Foothill Blvd Ste 15C
Glendale, CA 91214-1658
Phone
(818) 319-0224
NPI assigned
Jun 24, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 29, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LA2200X 95012147 CA
Gerontology Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LG0600X 95012147 CA Primary

Addresses

Primary practice location

3857 Foothill Blvd Ste 15C
Glendale, CA 91214-1658

Mailing address

11014 Eldora Ave
Sunland, CA 91040-2005

Other practice location 1

110 W Fir St Ste 4
Brea, CA 92821-6407
Phone (818) 319-0224

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
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95012147CAMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mhiramarc Healthcare Services Inc Home Health Current Accepting new patients
Mhiramarc Management LLC Home Health Services Home Health Current Accepting new patients

Locations

8350 Foothill Blvd
Sunland, CA 91040
Phone (818) 352-9560

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1182643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745884800000",
    "number": "1457557779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11014 ELDORA AVE",
            "city": "SUNLAND",
            "state": "CA",
            "postal_code": "910402005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3857 FOOTHILL BLVD STE 15C",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912141658",
            "telephone_number": "818-319-0224"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "110 W Fir St Ste 4",
            "address_purpose": "LOCATION",
            "city": "Brea",
            "state": "CA",
            "postal_code": "928216407",
            "country_code": "US",
            "telephone_number": "818-319-0224",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TARUC",
        "first_name": "FERNAND",
        "middle_name": "BAMBA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-24",
        "last_updated": "2025-04-29",
        "certification_date": "2025-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CA",
            "license": "95012147",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "CA",
            "license": "95012147",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2025; 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.