Active NPI
Letitia Renee Shackleford-Oliver
- Other Specialist/Technologist
- Vallejo, CA
National Provider Identifier
1730839085
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Specialist/Technologist
- Practice address
- 1628 Broadway St
Vallejo, CA 94590-2405 - Phone
- (077) 649-8300
- NPI assigned
- Mar 28, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Other Specialist/Technologist | 246Z00000X | Primary |
Addresses
Primary practice location
1628 Broadway St
Vallejo, CA 94590-2405
Mailing address
1628 Broadway St
Vallejo, CA 94590-2405
Phone (077) 649-8300
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1479 | Other | CA | TOWER ID |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1648425600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1648425600000",
"number": "1730839085",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1628 BROADWAY ST",
"city": "VALLEJO",
"state": "CA",
"postal_code": "945902405",
"telephone_number": "077-649-8300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1628 BROADWAY ST",
"city": "VALLEJO",
"state": "CA",
"postal_code": "945902405",
"telephone_number": "077-649-8300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHACKLEFORD-OLIVER",
"first_name": "LETITIA",
"middle_name": "RENEE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-03-28",
"last_updated": "2022-03-28",
"certification_date": "2022-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "246Z00000X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TOWER ID",
"identifier": "1479",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Vallejo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.