Active NPI
Gwen D. Mattox, LVN
- Licensed Vocational Nurse
- Merced, CA
National Provider Identifier
1649564121
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Vocational Nurse
- License
- 236591
- Practice address
- 300 E 15TH St
Merced, CA 95341-6217 - Phone
- (209) 381-6819
- Fax
- (209) 381-6871
- NPI assigned
- Jun 2, 2011
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Licensed Vocational Nurse | 164X00000X | 236591 | CA | Primary |
Addresses
Primary practice location
300 E 15TH St
Merced, CA 95341-6217
Mailing address
P O Box 2087
Merced, CA 95341-6217
Phone (209) 381-6819
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 |
|---|---|---|---|
| 236591 | CA | MD | Licensed Vocational Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1306972800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1453852800000",
"number": "1649564121",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P O BOX 2087",
"city": "MERCED",
"state": "CA",
"postal_code": "953416217",
"telephone_number": "209-381-6819",
"fax_number": "209-381-6871"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 E 15TH ST",
"city": "MERCED",
"state": "CA",
"postal_code": "953416217",
"telephone_number": "209-381-6819",
"fax_number": "209-381-6871"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATTOX",
"first_name": "GWEN",
"middle_name": "D.",
"credential": "LVN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-06-02",
"last_updated": "2016-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "164X00000X",
"taxonomy_group": "",
"desc": "Licensed Vocational Nurse",
"state": "CA",
"license": "236591",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Merced, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.