NPIMap

Organization Active NPI

Prototypes

  • Licensed Vocational Nurse
  • Pasadena, CA
National Provider Identifier
1659654986
Registry record updated Jun 28, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Vocational NurseTaxonomy code 164X00000X
License
VN240811 Issued in CA
Legal business name
PROTOTYPES
Practice address
2555 E. Colorado Blvd
Suite 100-101
Pasadena, CA 91107
Phone
(626) 577-2543
NPI assigned
Sep 22, 2011
Last updated
Jun 28, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2013

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

Authorized official

Name
Jeffery Havig, LVN
Title
Psychiatric Nurse
Phone
(909) 398-4383

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Vocational NurseGroup: 193200000X MULTI-SPECIALTY GROUP 164X00000X VN240811 CA Primary

Addresses

Primary practice location

2555 E. Colorado Blvd
Suite 100-101
Pasadena, CA 91107

Mailing address

831 East Arrow Highway
Pomona, CA 91767
Phone (909) 398-4383

National Provider Directory

National Provider Directory
Tax ID family
Prototypes Womens Center Outpatient10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1316649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372377600000",
    "number": "1659654986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "831 EAST ARROW HIGHWAY",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "91767",
            "telephone_number": "909-398-4383",
            "fax_number": "909-398-0127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2555 E. COLORADO BLVD",
            "address_2": "SUITE 100-101",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "91107",
            "telephone_number": "626-577-2543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROTOTYPES",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-22",
        "last_updated": "2013-06-28",
        "status": "A",
        "authorized_official_last_name": "HAVIG",
        "authorized_official_first_name": "JEFFERY",
        "authorized_official_title_or_position": "PSYCHIATRIC NURSE",
        "authorized_official_telephone_number": "909-398-4383",
        "authorized_official_credential": "LVN"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "VN240811",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pasadena, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 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.