Jack Gaines a Professional Corp.

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

License

C14269 Issued in CA

Legal business name

JACK GAINES A PROFESSIONAL CORP.

Practice address

4833 Rubio Ave
Encino, CA 91436-1118

Phone

(818) 981-4030

NPI assigned

Apr 1, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Jack W. Gaines, M.D.

Title

President

Phone

(818) 981-4030

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1364774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364774400000",
    "number": "1619210291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4833 RUBIO AVE",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914361118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4833 RUBIO AVE",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914361118",
            "telephone_number": "818-981-4030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK GAINES A PROFESSIONAL CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-01",
        "last_updated": "2013-04-01",
        "status": "A",
        "authorized_official_last_name": "GAINES",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-981-4030",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "CA",
            "license": "C14269",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Mental Health Clinic/Center in Encino, CA
• Providers in Encino, CA by specialty
• Adult Mental Health Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2013; 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.