Individual provider Active NPI

Mignonne Joan Dcruz

  • Family Nurse Practitioner
  • Burbank, CA
National Provider Identifier
1700489648
Registry record updated Sep 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95015706 Issued in CA
Practice address
511 N Hollywood Way
Burbank, CA 91505-3406
Phone
(818) 841-0710
NPI assigned
Nov 20, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 95015706 CA Primary

Addresses

Primary practice location

511 N Hollywood Way
Burbank, CA 91505-3406

Mailing address

511 N Hollywood Way
Burbank, CA 91505-3406
Phone (818) 841-0710

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)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95015706CAMDFamily Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1605830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630627200000",
    "number": "1700489648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "511 N HOLLYWOOD WAY",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915053406",
            "telephone_number": "818-841-0710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 N HOLLYWOOD WAY",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915053406",
            "telephone_number": "818-841-0710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DCRUZ",
        "first_name": "MIGNONNE",
        "middle_name": "JOAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-20",
        "last_updated": "2021-09-03",
        "certification_date": "2021-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95015706",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burbank, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2021; 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.