Active NPI
Elvy Adalie Fuentes
- Occupational Therapist
- Gardena, CA
National Provider Identifier
1538739552
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 22453
- Practice address
- 1203 W Gardena Blvd Apt B
Gardena, CA 90247-5056 - Phone
- (310) 982-3623
- NPI assigned
- Jun 30, 2021
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 22453 | CA | Primary |
Addresses
Primary practice location
1203 W Gardena Blvd Apt B
Gardena, CA 90247-5056
Mailing address
1203 W Gardena Blvd Apt B
Gardena, CA 90247-5056
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1625011200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1625011200000",
"number": "1538739552",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1203 W GARDENA BLVD APT B",
"city": "GARDENA",
"state": "CA",
"postal_code": "902475056"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1203 W GARDENA BLVD APT B",
"city": "GARDENA",
"state": "CA",
"postal_code": "902475056",
"telephone_number": "310-982-3623"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FUENTES",
"first_name": "ELVY",
"middle_name": "ADALIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-06-30",
"last_updated": "2021-06-30",
"certification_date": "2021-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CA",
"license": "22453",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gardena, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.