Individual provider Active NPI

Jesus Verduzco

  • Student in an Organized Health Care Education/Training Program
  • Los Angeles, CA
National Provider Identifier
1841841269
Registry record updated Nov 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
4401 Crenshaw Blvd
Los Angeles, CA 90043-1227
Phone
(323) 290-8360
NPI assigned
Sep 26, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X
Case Manager/Care Coordinator 171M00000X CA
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

4401 Crenshaw Blvd
Los Angeles, CA 90043-1227

Mailing address

3031 S Vermont Ave
Los Angeles, CA 90007-3033
Phone (323) 373-2400

Other practice location 1

4211 Avalon Blvd
Los Angeles, CA 90011-5699
Phone (323) 233-0425

Other practice location 2

3311 Candelaria Rd NE Ste 3311-A
Albuquerque, NM 87107-1959
Phone (818) 241-6780

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

Practice roles

OrganizationSpecialtyStatusNew patients
Wellnest Emotional Health & Wellness CurrentSince Nov 10, 2024 Accepting new patients

Locations

4401 Crenshaw Blvd
Los Angeles, CA 90043
Phone (323) 290-8360

3031 S Vermont Ave
Los Angeles, CA 90007
Phone (323) 766-2345

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": "1569456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730851200000",
    "number": "1841841269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3031 S VERMONT AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900073033",
            "telephone_number": "323-373-2400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4401 CRENSHAW BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900431227",
            "telephone_number": "323-290-8360"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4211 Avalon Blvd",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900115699",
            "country_code": "US",
            "telephone_number": "323-233-0425",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3311 Candelaria Rd NE Ste 3311-A",
            "address_purpose": "LOCATION",
            "city": "Albuquerque",
            "state": "NM",
            "postal_code": "871071959",
            "country_code": "US",
            "telephone_number": "818-241-6780",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VERDUZCO",
        "first_name": "JESUS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-09-26",
        "last_updated": "2024-11-06",
        "certification_date": "2024-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 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.

Verify at the official NPI Registry.