Individual provider Active NPI

Nancy Kavianian, NP

  • Women's Health Nurse Practitioner
  • Cathedral City, CA
National Provider Identifier
1720127392
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Women's Health Nurse PractitionerTaxonomy code 363LW0102X
License
NP7747 Issued in CA
Practice address
69175 Ramon Rd BLDG a
Cathedral City, CA 92234-3344
Phone
(760) 321-6776
Fax
(760) 321-4036
NPI assigned
Feb 6, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Women's Health Nurse Practitioner 363LW0102X NP7747 CA Primary

Addresses

Primary practice location

69175 Ramon Rd BLDG a
Cathedral City, CA 92234-3344

Mailing address

PO Box 2369
Borrego Springs, CA 92004-2369
Phone (760) 767-5051

Other identifiers 2

IdentifierTypeStateIssuer
KAV104305075OtherCANCC ID
RN353978OtherCARN LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120913000647 CA Order and Referring Only - Nurse Practitioner 7416105564

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
NP7747CAMDWomen's Health Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1720127392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2369",
            "city": "BORREGO SPRINGS",
            "state": "CA",
            "postal_code": "920042369",
            "telephone_number": "760-767-5051",
            "fax_number": "760-767-4552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "69175 RAMON RD BLDG A",
            "city": "CATHEDRAL CITY",
            "state": "CA",
            "postal_code": "922343344",
            "telephone_number": "760-321-6776",
            "fax_number": "760-321-4036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAVIANIAN",
        "first_name": "NANCY",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "CA",
            "license": "NP7747",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCC ID",
            "identifier": "KAV104305075",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RN LICENSE",
            "identifier": "RN353978",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cathedral City, CA

Sources for this page

Verify at the official NPI Registry.