Active NPI
Tierra Fuller
- Rehabilitation Practitioner
- View Park, CA
National Provider Identifier
1669946372
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Practitioner
- Practice address
- 5300 Angeles Vista Blvd
View Park, CA 90043 - Phone
- (323) 295-4555
- NPI assigned
- Jan 15, 2019
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | |||
| Rehabilitation Practitioner | 225400000X | Primary |
Addresses
Primary practice location
5300 Angeles Vista Blvd
View Park, CA 90043
Mailing address
5300 Angeles Vista Blvd
View Park, CA 90043-1648
Phone (323) 295-4555
Other practice location 1
5201 S Vermont Ave
Los Angeles, CA 90037-3527
Phone (323) 751-3026
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southern California Health & Rehabilitation Program | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Community/Behavioral Health Agency
- Lynwood, CA
- NPI 1467775221
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1547510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560297600000",
"number": "1669946372",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5300 ANGELES VISTA BLVD",
"city": "VIEW PARK",
"state": "CA",
"postal_code": "900431648",
"telephone_number": "323-295-4555"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5300 ANGELES VISTA BLVD",
"city": "VIEW PARK",
"state": "CA",
"postal_code": "90043",
"telephone_number": "323-295-4555"
}
],
"practiceLocations": [
{
"address_1": "5201 S Vermont Ave",
"address_purpose": "LOCATION",
"city": "Los Angeles",
"state": "CA",
"postal_code": "900373527",
"country_code": "US",
"telephone_number": "323-751-3026",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "FULLER",
"first_name": "TIERRA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-01-15",
"last_updated": "2019-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": false
},
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in View Park, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.