Individual provider Active NPI

Yvette Grace Liberty, REGISTERED NURSE

  • Registered Nurse
  • Costa Mesa, CA
National Provider Identifier
1790006898
Registry record updated Jun 13, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
749771 Issued in CA
Practice address
3457 Fuchsia St
Costa Mesa, CA 92626-1713
Phone
(714) 785-1114
NPI assigned
Jun 13, 2010
Last updated
Jun 13, 2010By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 13, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 749771 CA Primary

Addresses

Primary practice location

3457 Fuchsia St
Costa Mesa, CA 92626-1713

Mailing address

3457 Fuchsia St
Costa Mesa, CA 92626-1713
Phone (714) 785-1114

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

State licenses

LicenseStateTypeSpecialty
749771CAMDRegistered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1276387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1276387200000",
    "number": "1790006898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3457 FUCHSIA ST",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926261713",
            "telephone_number": "714-785-1114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3457 FUCHSIA ST",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926261713",
            "telephone_number": "714-785-1114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIBERTY",
        "first_name": "YVETTE",
        "middle_name": "GRACE",
        "name_prefix": "Mrs.",
        "credential": "REGISTERED NURSE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-06-13",
        "last_updated": "2010-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "749771",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Costa Mesa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.