Active NPI
Mary Katheryn Gardner
- Dental Assistant
- Redondo Beach, CA
National Provider Identifier
1588086680
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Assistant
- License
- 68677
- Practice address
- 18515 Mansel Ave
Redondo Beach, CA 90278-4642 - Phone
- (310) 507-5756
- NPI assigned
- Jan 9, 2014
- 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 |
|---|---|---|---|---|
| Dental Assistant | 126800000X | 68677 | CA | Primary |
Addresses
Primary practice location
18515 Mansel Ave
Redondo Beach, CA 90278-4642
Mailing address
18515 Mansel Ave
Redondo Beach, CA 90278-4642
Phone (310) 507-5756
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 68677 | Other | CA | RDA LICENSE |
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": "1389225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1389225600000",
"number": "1588086680",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18515 MANSEL AVE",
"city": "REDONDO BEACH",
"state": "CA",
"postal_code": "902784642",
"telephone_number": "310-507-5756"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18515 MANSEL AVE",
"city": "REDONDO BEACH",
"state": "CA",
"postal_code": "902784642",
"telephone_number": "310-507-5756"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GARDNER",
"first_name": "MARY",
"middle_name": "KATHERYN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-01-09",
"last_updated": "2014-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "126800000X",
"taxonomy_group": "",
"desc": "Dental Assistant",
"state": "CA",
"license": "68677",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RDA LICENSE",
"identifier": "68677",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Redondo Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.