NPIMap

Organization Active NPI

Outreach Nation Clinics

  • Clinical Social Worker
  • Rancho Cucamonga, CA
National Provider Identifier
1457963076
Registry record updated Aug 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
OUTREACH NATION CLINICS
Practice address
9375 Archibald Ave Ste 107
Rancho Cucamonga, CA 91730-5728
Phone
(909) 825-8080
Fax
(909) 360-1550
NPI assigned
Aug 17, 2020
Last updated
Aug 17, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2020

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

Authorized official

Name
Mrs. Khalida Khanum
Title
Program Director
Phone
(909) 825-8080

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X NU Primary
Marriage & Family Therapist 106H00000X NU

Addresses

Primary practice location

9375 Archibald Ave Ste 107
Rancho Cucamonga, CA 91730-5728

Mailing address

9375 Archibald Ave Ste 107
Rancho Cucamonga, CA 91730-5728
Phone (909) 825-8080

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kk@outreachnation.com Direct

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1597622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597622400000",
    "number": "1457963076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9375 ARCHIBALD AVE STE 107",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917305728",
            "telephone_number": "909-825-8080",
            "fax_number": "909-360-1550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9375 ARCHIBALD AVE STE 107",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917305728",
            "telephone_number": "909-825-8080",
            "fax_number": "909-360-1550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUTREACH NATION CLINICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-17",
        "last_updated": "2020-08-17",
        "certification_date": "2020-08-17",
        "status": "A",
        "authorized_official_last_name": "KHANUM",
        "authorized_official_first_name": "KHALIDA",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "909-825-8080",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kk@outreachnation.com",
            "affiliation": "N",
            "endpointDescription": "Khalida Khanum - Administrative Director",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "9375 Archibald Ave Ste 107",
            "city": "Rancho Cucamonga",
            "state": "CA",
            "country_code": "US",
            "postal_code": "917305728",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Rancho Cucamonga, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2020; 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.