Individual provider Active NPI

Danille P Ijoma

  • Licensed Vocational Nurse
  • La Verne, CA
National Provider Identifier
1619097433
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Vocational NurseTaxonomy code 164X00000X
License
195295 Issued in CA
Practice address
233 Base Line Rd
La Verne, CA 91750-2353
Phone
(909) 593-2581
NPI assigned
Mar 29, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Vocational Nurse 164X00000X 195295 CA Primary

Addresses

Primary practice location

233 Base Line Rd
La Verne, CA 91750-2353

Mailing address

233 Base Line Rd
La Verne, CA 91750-2353
Phone (909) 593-2581

Other identifiers 1

IdentifierTypeStateIssuer
7565AOtherCAOUT PATIENT MENTAL HEALTH

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

State licenses

LicenseStateTypeSpecialty
195295CAMDLicensed Vocational Nurse

NPI Registry JSON

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1619097433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "233 BASE LINE RD",
            "city": "LA VERNE",
            "state": "CA",
            "postal_code": "917502353",
            "telephone_number": "909-593-2581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "233 BASE LINE RD",
            "city": "LA VERNE",
            "state": "CA",
            "postal_code": "917502353",
            "telephone_number": "909-593-2581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IJOMA",
        "first_name": "DANILLE",
        "middle_name": "P",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "195295",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OUT PATIENT MENTAL HEALTH",
            "identifier": "7565A",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in La Verne, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.