Active NPI
Shane Richard Wurdeman, CP
- Prosthetist
- Los Angeles, CA
National Provider Identifier
1497911572
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetist
- License
- CP003610
- Practice address
- 11301 Wilshire Blvd
BLDG 304
Los Angeles, CA 90073-1003 - Phone
- (310) 478-3711
- NPI assigned
- Jul 29, 2008
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Prosthetist | 224P00000X | CP003610 | CA | Primary |
Addresses
Primary practice location
11301 Wilshire Blvd
BLDG 304
Los Angeles, CA 90073-1003
Mailing address
1323 14TH St
Apt. E
Santa Monica, CA 90404-1744
Phone (310) 478-3711
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
| License | State | Type | Specialty |
|---|---|---|---|
| CP003610 | CA | MD | Prosthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1217289600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1217289600000",
"number": "1497911572",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1323 14TH ST",
"address_2": "APT. E",
"city": "SANTA MONICA",
"state": "CA",
"postal_code": "904041744",
"telephone_number": "310-478-3711"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11301 WILSHIRE BLVD",
"address_2": "BLDG 304",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900731003",
"telephone_number": "310-478-3711"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WURDEMAN",
"first_name": "SHANE",
"middle_name": "RICHARD",
"credential": "CP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-07-29",
"last_updated": "2008-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "224P00000X",
"taxonomy_group": "",
"desc": "Prosthetist",
"state": "CA",
"license": "CP003610",
"primary": true
}
],
"identifiers": [],
"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 Jul 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.