Active NPI
Justin Oderkirk
- Basic Emergency Medical Technician
- San Diego, CA
National Provider Identifier
1861539488
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Basic Emergency Medical Technician
- License
- B1662309
- Practice address
- 1650 Henderson Ave
BLDG 310
San Diego, CA 92140 - Phone
- (619) 524-8673
- NPI assigned
- Jan 31, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Basic Emergency Medical Technician | 146N00000X | B1662309 | CA | Primary |
Addresses
Primary practice location
1650 Henderson Ave
BLDG 310
San Diego, CA 92140
Mailing address
1650 Henderson Ave
BLDG 310
San Diego, CA 92140
Phone (619) 524-8673
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 |
|---|---|---|---|
| B1662309 | CA | MD | Basic Emergency Medical Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1861539488",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1650 HENDERSON AVE",
"address_2": "BLDG 310",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "92140",
"telephone_number": "619-524-8673"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1650 HENDERSON AVE",
"address_2": "BLDG 310",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "92140",
"telephone_number": "619-524-8673"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ODERKIRK",
"first_name": "JUSTIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "146N00000X",
"taxonomy_group": "",
"desc": "Emergency Medical Technician, Basic",
"state": "CA",
"license": "B1662309",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.