Watipaso Ziba
Individual provider Active NPI Family Nurse Practitioner · Mountain House, CA
NPI 1700276151 · NPPES record last updated Feb 11, 2015
Key facts
- NPI
- 1700276151
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 95002106 (CA)
- Practice address
- 623 Antigua Ter
Mountain House, CA 95391-1284 - Phone
- (209) 879-9719
- NPI assigned
- Jan 23, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Stat Med PC a California Medical Professional Corporation
Practice addresses (Care Compare)
901 Sunvalley Blvd
Suite 100
Concord, CA 94520-5816
Phone (925) 234-4447
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160113002932 | CA | Practitioner - Nurse Practitioner | 7719289388 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Stat Med PC a California Medical Professional Corporation | Current |
Accepting new patients | |
| California Urgent Care Center Professional Corporation | Current |
Accepting new patients | |
| Stat Med PC a California Medical Professional Corporation | Current |
Accepting new patients | |
| Mercy West Urgent Care Inc | Past | Accepting new patients |
Locations
5951 Lone Tree Way
Ste 100
Brentwood, CA 94513
Phone (925) 234-4447
901 Sunvalley Blvd
Ste 100
Concord, CA 94520
Phone (925) 234-4447
3779 Mt Diablo Blvd Ste 100
Lafayette, CA 94549
4465 1st St
Livermore, CA 94551
Phone (925) 234-4447
2122 W Kettleman Ln
Lodi, CA 95242
Phone (209) 224-8512
8001 Lorraine Ave
Stockton, CA 95210
Phone (209) 472-7400
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 835953 | CA | |
| Family Nurse Practitioner | 363LF0000X | 95002106 | CA | Yes |
Addresses
Primary practice location
623 Antigua Ter
Mountain House, CA 95391-1284
Mailing address
623 Antigua Ter
Mountain House, CA 95391-1284
Phone (209) 879-9719
Other providers in Mountain House, CA
All providers in Mountain House, CA · Family Nurse Practitioner in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 11, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.