Kevin San Luis, DNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

2024026806 Issued in CA

Practice address

11900 Avalon Blvd Ste 100
Los Angeles, CA 90061-2867

Phone

(888) 783-1883

NPI assigned

Jun 18, 2024

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Morante Psychiatric Nursing PC

  • Psychiatric/Mental Health Nurse Practitioner
  • Los Angeles, CA
  • NPI 1184326944
  Medicare reassignment NPD
• Procura Wound Care

  • General Practice Physician
  • Phoenix, AZ
  • NPI 1033096169
  NPD (past)

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

{
    "created_epoch": "1718668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737936000000",
    "number": "1639912488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11900 AVALON BLVD STE 100",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900612867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11900 AVALON BLVD STE 100",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900612867",
            "telephone_number": "888-783-1883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAN LUIS",
        "first_name": "KEVIN",
        "credential": "DNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-06-18",
        "last_updated": "2025-01-27",
        "certification_date": "2025-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "2024026806",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• San Judas Community Health Center, Inc.
• San Judas Medical Group Ipa
• San Judas Medical Group West
• Victor M San Lucas III III, CRNA
• San Lucas Medical Clinic, Inc.
• San Mateo Medical Clinic, Inc
• Jacqueline San Nicolas
• San Vicente Surgery Center, LLC
• San Vicente Women'S Total Health Center Inc
• San Vincente Women'S Total Health Center Inc

• Psychiatric/Mental Health Nurse Practitioner in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2025; 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.

Verify at the official NPI Registry.