Active NPI
Rosa Davitan
- Durable Medical Equipment & Medical Supplies
- Los Angeles, CA
National Provider Identifier
1619156197
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Durable Medical Equipment & Medical Supplies
- License
- 000203078800010
- Practice address
- 4369 S Van Ness Ave
Los Angeles, CA 90062-1454 - Phone
- (323) 292-3558
- Fax
- (323) 292-3688
- NPI assigned
- Oct 31, 2007
- 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 |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 000203078800010 | CA | Primary |
Addresses
Primary practice location
4369 S Van Ness Ave
Los Angeles, CA 90062-1454
Mailing address
4369 S Van Ness Ave
Los Angeles, CA 90062-1454
Phone (323) 292-3558
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
| License | State | Type | Specialty |
|---|---|---|---|
| 000203078800010 | CA | MD | Durable Medical Equipment & Medical Supplies |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193788800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193875200000",
"number": "1619156197",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4369 S VAN NESS AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900621454",
"telephone_number": "323-292-3558",
"fax_number": "323-292-3688"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4369 S VAN NESS AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900621454",
"telephone_number": "323-292-3558",
"fax_number": "323-292-3688"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVITAN",
"first_name": "ROSA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-10-31",
"last_updated": "2007-11-01",
"status": "A"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "CA",
"license": "000203078800010",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 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.