Active NPI
Jennifer Nitollama, PT, PCS
- Physical Therapist
- Orange, CA
National Provider Identifier
1851745822
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 36549
- Practice address
- 11402 S Church St
Orange, CA 92869-2620 - Phone
- (714) 651-6008
- NPI assigned
- Apr 15, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 36549 | CA | Primary |
| Pediatric Physical Therapist | 2251P0200X | 36549 | CA |
Addresses
Primary practice location
11402 S Church St
Orange, CA 92869-2620
Mailing address
11402 S Church St
Orange, CA 92869-2620
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
| License | State | Type | Specialty |
|---|---|---|---|
| 36549 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1460678400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1460678400000",
"number": "1851745822",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11402 S CHURCH ST",
"city": "ORANGE",
"state": "CA",
"postal_code": "928692620"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11402 S CHURCH ST",
"city": "ORANGE",
"state": "CA",
"postal_code": "928692620",
"telephone_number": "714-651-6008"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NITOLLAMA",
"first_name": "JENNIFER",
"name_prefix": "Mrs.",
"credential": "PT, PCS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-04-15",
"last_updated": "2016-04-15",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "36549",
"primary": true
},
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "CA",
"license": "36549",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orange, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.