Active NPI
Breidi A. Calloway, NP
- Nurse Practitioner
- Los Angeles, CA
National Provider Identifier
1710281233
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 18343
- Practice address
- 1441 Eastlake Ave
Nor 8302E
Los Angeles, CA 90089-0112 - Phone
- (323) 865-3105
- Fax
- (323) 865-0061
- NPI assigned
- Dec 23, 2010
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | 18343 | CA | |
| Oncology Clinic/Center | 261QX0200X | 18343 | CA | |
| Nurse Practitioner | 363L00000X | 18343 | CA | Primary |
Addresses
Primary practice location
1441 Eastlake Ave
Nor 8302E
Los Angeles, CA 90089-0112
Mailing address
PO Box 31309
Los Angeles, CA 90031-0309
Phone (323) 442-5100
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| W18762 | Other | CA | GROUP MEDICARE |
| 1902846306 | Other | CA | GROUP NPI |
| GR0100430 | Other | CA | GROUP MEDICAL |
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
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18343 | CA | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1293062400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1333411200000",
"number": "1710281233",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 31309",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900310309",
"telephone_number": "323-442-5100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1441 EASTLAKE AVE",
"address_2": "NOR 8302E",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900890112",
"telephone_number": "323-865-3105",
"fax_number": "323-865-0061"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CALLOWAY",
"first_name": "BREIDI",
"middle_name": "A.",
"credential": "NP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-12-23",
"last_updated": "2012-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "261QP2300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Primary Care",
"state": "CA",
"license": "18343",
"primary": false
},
{
"code": "261QX0200X",
"taxonomy_group": "",
"desc": "Clinic/Center, Oncology",
"state": "CA",
"license": "18343",
"primary": false
},
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "CA",
"license": "18343",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GROUP MEDICARE",
"identifier": "W18762",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GROUP NPI",
"identifier": "1902846306",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GROUP MEDICAL",
"identifier": "GR0100430",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.