Active NPI
Lacee Oliver, PA
- Medical Physician Assistant
- Orange, CA
National Provider Identifier
1891331385
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA57170
- Practice address
- 2592 N Santiago Blvd
Orange, CA 92867-1862 - Phone
- (714) 330-7921
- NPI assigned
- Nov 20, 2019
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA57170 | CA | Primary |
Addresses
Primary practice location
2592 N Santiago Blvd
Orange, CA 92867-1862
Mailing address
7290 Edinger Ave Unit 4138
Huntington Beach, CA 92647-0957
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200416001045 | CA | Practitioner - Physician Assistant | 5395175277 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA57170 | CA | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1574208000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1574208000000",
"number": "1891331385",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7290 EDINGER AVE UNIT 4138",
"city": "HUNTINGTON BEACH",
"state": "CA",
"postal_code": "926470957"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2592 N SANTIAGO BLVD",
"city": "ORANGE",
"state": "CA",
"postal_code": "928671862",
"telephone_number": "714-330-7921"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLIVER",
"first_name": "LACEE",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-11-20",
"last_updated": "2019-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "CA",
"license": "PA57170",
"primary": true
}
],
"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 Nov 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.