Active NPI
Tina Khosravi
- Medical Physician Assistant
- Orange, CA
National Provider Identifier
1609301506
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- Practice address
- 705 W la Veta Ave Ste 109
Orange, CA 92868-4447 - Phone
- (714) 628-9342
- NPI assigned
- Apr 27, 2017
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | Primary |
Addresses
Primary practice location
705 W la Veta Ave Ste 109
Orange, CA 92868-4447
Mailing address
705 W la Veta Ave Ste 109
Orange, CA 92868-4447
Phone (714) 628-9342
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 54788 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Onclick Healthcare Incorporated | Current | Accepting new patients | |
| Altea Medical California PC | Current | Accepting new patients | |
| Mobile Physicians Medical Allied Group Inc | Past | Accepting new patients |
Locations
1795 Walnut St
Red Bluff, CA 96080
Phone (530) 527-2046
2005 River St
Susanville, CA 96130
Phone (530) 257-5341
Interoperability endpoints
- tina.khosravi@3856.securemail.prognocis.com
Organizations & group practices 5
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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-
- Primary Care Nurse Practitioner
- West Covina, CA
- NPI 1578019485
-
- Adolescent Medicine (Family Medicine) Physician
- West Covina, CA
- NPI 1629682067
-
- Family Medicine Physician
- West Covina, CA
- NPI 1184199275
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1493251200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1511740800000",
"number": "1609301506",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "705 W LA VETA AVE STE 109",
"city": "ORANGE",
"state": "CA",
"postal_code": "928684447",
"telephone_number": "714-628-9342"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "705 W LA VETA AVE STE 109",
"city": "ORANGE",
"state": "CA",
"postal_code": "928684447",
"telephone_number": "714-628-9342"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHOSRAVI",
"first_name": "TINA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-04-27",
"last_updated": "2017-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orange, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2017; 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.