Active NPI
Jeffrey Andrew Van Gorder
- Lodging Provider
- La Verne, CA
National Provider Identifier
1760290894
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Lodging Provider
- Practice address
- 6425 Canterwood Rd
La Verne, CA 91750-1211 - Phone
- (909) 267-4342
- NPI assigned
- Dec 20, 2024
- Last updated
- Dec 20, 2024
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Lodging Provider | 177F00000X | NU | Primary |
Addresses
Primary practice location
6425 Canterwood Rd
La Verne, CA 91750-1211
Mailing address
6425 Canterwood Rd
La Verne, CA 91750-1211
Phone (909) 267-4342
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": "1734652800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1734652800000",
"number": "1760290894",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6425 CANTERWOOD RD",
"city": "LA VERNE",
"state": "CA",
"postal_code": "917501211",
"telephone_number": "909-267-4342"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6425 CANTERWOOD RD",
"city": "LA VERNE",
"state": "CA",
"postal_code": "917501211",
"telephone_number": "909-267-4342"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN GORDER",
"first_name": "JEFFREY",
"middle_name": "ANDREW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-12-20",
"last_updated": "2024-12-20",
"certification_date": "2024-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "177F00000X",
"taxonomy_group": "",
"desc": "Lodging",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Verne, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.