Individual provider Active NPI

Jessica Nicole Sota, FNP

  • Family Nurse Practitioner
  • Long Beach, CA
National Provider Identifier
1790464634
Registry record updated Apr 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95025985 Issued in CA
Practice address
300 Redondo Ave
Long Beach, CA 90814-2651
Phone
(562) 433-7496
Fax
(529) 978-9206
NPI assigned
Jul 17, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 95025985 CA Primary

Addresses

Primary practice location

300 Redondo Ave
Long Beach, CA 90814-2651

Mailing address

300 Redondo Ave
Long Beach, CA 90814-2651
Phone (562) 433-7496

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
I20240306000588 CA Practitioner - Nurse Practitioner 0547606162 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Prohealth Partners a Medical Group Inc CurrentSince Feb 1, 2024 Accepting new patients
Prohealth Partners, a Medical Group, Inc. CurrentSince Feb 1, 2024 Accepting new patients
Prohealth Partners, a Medical Group Current Accepting new patients
Prohealth Partners a Medical Group Inc Past Accepting new patients

Locations

300 Redondo Ave
Long Beach, CA 90814
Phone (562) 433-7496

300 Redondo Ave
Ste 500
Long Beach, CA 90814

300 Redondo Ave
Ste B
Long Beach, CA 90814
Phone (562) 433-7496

File 54567
Los Angeles, CA 90074
Phone (310) 491-9060

Organizations & group practices 4

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": "1689552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714003200000",
    "number": "1790464634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 REDONDO AVE",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908142651",
            "telephone_number": "562-433-7496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 REDONDO AVE",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908142651",
            "telephone_number": "562-433-7496",
            "fax_number": "529-978-9206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOTA",
        "first_name": "JESSICA",
        "middle_name": "NICOLE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-17",
        "last_updated": "2024-04-25",
        "certification_date": "2024-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95025985",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

Verify at the official NPI Registry.