Jamie Carissa D Plata

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

30771 Issued in CA

Practice address

75 N Santa Anita Ave Ste 105
Arcadia, CA 91006-3157

Phone

(626) 623-6355

NPI assigned

Sep 12, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Jamie Carissa M De la Cruz Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Eastern New Mexico University

  • Speech-Language Pathologist
  • Portales, NM
  • NPI 1356115273
  NPD (past)

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

{
    "created_epoch": "1505174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603756800000",
    "number": "1801315734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "329 E CALIFORNIA BLVD APT 2",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911063656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 N SANTA ANITA AVE STE 105",
            "city": "ARCADIA",
            "state": "CA",
            "postal_code": "910063157",
            "telephone_number": "626-623-6355"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1500 S Ave K",
            "address_2": "Station 3, SHROC",
            "address_purpose": "LOCATION",
            "city": "Portales",
            "state": "NM",
            "postal_code": "88130",
            "country_code": "US",
            "telephone_number": "575-562-2160",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PLATA",
        "first_name": "JAMIE CARISSA",
        "middle_name": "D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-12",
        "last_updated": "2020-10-27",
        "certification_date": "2020-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2355S0801X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Speech-Language Assistant",
            "state": "CA",
            "license": "4799",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "14044",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "30771",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JAMIE CARISSA",
            "last_name": "DE LA CRUZ",
            "middle_name": "M",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Speech-Language Pathologist in Arcadia, CA
• Providers in Arcadia, CA by specialty
• Speech-Language Pathologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2020; 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.