Deodra Broadnax

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

Practice address

1451 Marine Ave Apt D
Gardena, CA 90247-3331

Phone

(310) 991-0023

NPI assigned

Jul 27, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1595808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595808000000",
    "number": "1548879489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7857 FLORENCE AVE # 112",
            "city": "DOWNEY",
            "state": "CA",
            "postal_code": "902403700",
            "telephone_number": "310-991-0023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1451 MARINE AVE APT D",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902473331",
            "telephone_number": "310-991-0023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADNAX",
        "first_name": "DEODRA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-07-27",
        "last_updated": "2020-07-27",
        "certification_date": "2020-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tiffany Shiffon Briggs, BSW
• Ashley Jasmine Briones
• Juan Jose Briseno
• Anna Bristol
• La Mika M Broadnax-Evans
• Hilarry Dian Broaster, PHARM.D
• Diamond Brock
• Rayme Michael Brock, R.N.
• Ametra Broome
• Ronak Broukhim

• Developmentally Disabled Services Day Training Agency in Gardena, CA
• Providers in Gardena, CA by specialty
• Developmentally Disabled Services Day Training Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 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.