Individual provider Active NPI

Latosha Dent

  • Psychiatric/Mental Health Nurse Practitioner
  • Burbank, CA
National Provider Identifier
1578033593
Registry record updated Jul 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
95010715 Issued in CA
Practice address
1812 W Burbank Blvd # 5300
Burbank, CA 91506-1315
Phone
(206) 430-8118
NPI assigned
Dec 3, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 20, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X AP60903459 WA
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 95010715 CA Primary

Addresses

Primary practice location

1812 W Burbank Blvd # 5300
Burbank, CA 91506-1315

Mailing address

1812 W Burbank Blvd # 5300
Burbank, CA 91506-1315

Other practice location 1

4730 University Way NE Ste 104
Seattle, WA 98105-4424
Phone (206) 627-0995

Other identifiers 1

IdentifierTypeStateIssuer
5966342MedicaidCA

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)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP60903459WAMDPsychiatric/Mental Health Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1543795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595203200000",
    "number": "1578033593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1812 W BURBANK BLVD # 5300",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915061315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1812 W BURBANK BLVD # 5300",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915061315",
            "telephone_number": "206-430-8118"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4730 University Way NE Ste 104",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981054424",
            "country_code": "US",
            "telephone_number": "206-627-0995",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DENT",
        "first_name": "LATOSHA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-12-03",
        "last_updated": "2020-07-20",
        "certification_date": "2020-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP60903459",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95010715",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5966342",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burbank, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 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.