Individual provider Active NPI

Roselou R Perun, NP

  • Nurse Practitioner
  • Los Angeles, CA
National Provider Identifier
1780958330
Registry record updated Aug 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
21190 Issued in CA
Practice address
1520 San Pablo St Ste 3000
Los Angeles, CA 90033-5315
Phone
(323) 442-8545
NPI assigned
Feb 29, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 21190 CA Primary

Addresses

Primary practice location

1520 San Pablo St Ste 3000
Los Angeles, CA 90033-5315

Mailing address

127 Pamela Rd
Monrovia, CA 91016-5034
Phone (323) 708-9198

Other practice location 1

1520 San Pablo St
Suite 1000
Los Angeles, CA 90033-5310
Phone (323) 442-5100

Other practice location 2

1500 San Pablo St
Los Angeles, CA 90033-5313
Phone (323) 442-8545

Other identifiers 3

IdentifierTypeStateIssuer
1902846306OtherCAGROUP NPI
GR0100430OtherCAGROUP MEDI-CAL
W18762OtherCAGROUP MEDICARE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address roselou.rabara@direct.usc.edu Direct

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
I20121030000470 CA Practitioner - Nurse Practitioner 9335399286 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
21190CAMDMarriage & Family Therapist

Interoperability endpoints

  • Direct secure messaging: roselou.rabara@direct.usc.edu
  • Direct secure messaging: rperun1181046@direct.uclahealth.org

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1330473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597968000000",
    "number": "1780958330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 PAMELA RD",
            "city": "MONROVIA",
            "state": "CA",
            "postal_code": "910165034",
            "telephone_number": "323-708-9198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 SAN PABLO ST STE 3000",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900335315",
            "telephone_number": "323-442-8545"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1520 San Pablo St",
            "address_2": "Suite 1000",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900335310",
            "country_code": "US",
            "telephone_number": "323-442-5100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1500 San Pablo St",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900335313",
            "country_code": "US",
            "telephone_number": "323-442-8545",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PERUN",
        "first_name": "ROSELOU",
        "middle_name": "R",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-29",
        "last_updated": "2020-08-21",
        "certification_date": "2020-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "21190",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1902846306",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDI-CAL",
            "identifier": "GR0100430",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICARE",
            "identifier": "W18762",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "roselou.rabara@direct.usc.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1520 San Pablo St Ste 3000",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900335315",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.