Active NPI
Evan Pacleb
- Nurse Practitioner
- San Diego, CA
National Provider Identifier
1518793983
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 95032083
- Practice address
- 4875 Cole St Unit 50
San Diego, CA 92117-1864 - Phone
- (678) 763-2684
- NPI assigned
- Sep 11, 2024
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 95032083 | CA | Primary |
Addresses
Primary practice location
4875 Cole St Unit 50
San Diego, CA 92117-1864
Mailing address
4875 Cole St Unit 50
San Diego, CA 92117-1864
Phone (678) 763-2684
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95032083 | CA | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sinu-Clear Inc | Current | Accepting new patients |
Locations
9620 Fremont Ave
Montclair, CA 91763
Phone (909) 227-0750
1550 N Park Ave
Pomona, CA 91768
Phone (909) 623-0791
Organizations & group practices 1
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1726012800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1726012800000",
"number": "1518793983",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4875 COLE ST UNIT 50",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921171864",
"telephone_number": "678-763-2684"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4875 COLE ST UNIT 50",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921171864",
"telephone_number": "678-763-2684"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PACLEB",
"first_name": "EVAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-09-11",
"last_updated": "2024-09-11",
"certification_date": "2024-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "CA",
"license": "95032083",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.