La Lakers

Primary specialty

General Acute Care HospitalTaxonomy code 282N00000X

Legal business name

LA LAKERS

Practice address

2101 NE 2ND St Apt 114
Gainesville, FL 32609-8626

Phone

(352) 792-8069

NPI assigned

Apr 6, 2019

Organization subpart

Yes

Parent organization

000018As reported in NPPES

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

Authorized official

Name

Raven Shenette Mayes, DO

Title

Healthcare Manager

Phone

(352) 792-8069

Specialties & licenses 1

Addresses

Other identifiers 5

Tax ID family

La Lakers6 organizations share this tax ID, including this one

Part of

La Lakers

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

• Acute Care

  • Nursing Care Agency
  • Gainesville, FL
  • NPI 1043973910
  NPD tax ID
• La Lakers

  • Optometrist
  • Gainesville, FL
  • NPI 1134682263
  NPD tax ID
• La Lakers

  • Primary Care Clinic/Center
  • Gainesville, FL
  • NPI 1578228375
  NPD tax ID
• Acute Care

  • Health Service Clinic/Center
  • El Segundo, CA
  • NPI 1639632763
  NPD tax ID
• La Lakers

  • Early Intervention Provider Agency
  • El Segundo, CA
  • NPI 1043773179
  NPD tax ID

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Keith Arnett Jones, ATC

  • Athletic Trainer
  • Houston, TX
  • NPI 1902568066
  NPD (past)
• Raven Shenette Mayes James, ONA/MD/ARNP

  • Nurse Practitioner
  • El Segundo, CA
  • NPI 1558829721

  Driver

  NPD (past)

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

{
    "created_epoch": "1554508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618531200000",
    "number": "1972065001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 NE 2ND ST APT 114",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326098626",
            "telephone_number": "352-792-8069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 NE 2ND ST APT 114",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326098626",
            "telephone_number": "352-792-8069"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Legends Way",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021141300",
            "country_code": "US",
            "telephone_number": "617-624-1050",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2275 E Mariposa Ave",
            "address_purpose": "LOCATION",
            "city": "El Segundo",
            "state": "CA",
            "postal_code": "902455029",
            "country_code": "US",
            "telephone_number": "310-426-6000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1011 Broadway",
            "address_purpose": "LOCATION",
            "city": "Oakland",
            "state": "CA",
            "postal_code": "946074019",
            "country_code": "US",
            "telephone_number": "510-986-2200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1510 Polk St",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770021099",
            "country_code": "US",
            "telephone_number": "713-758-7200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1601 SW Archer Rd",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "FL",
            "postal_code": "326081135",
            "country_code": "US",
            "telephone_number": "352-270-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LA LAKERS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "000018",
        "enumeration_date": "2019-04-06",
        "last_updated": "2021-04-16",
        "certification_date": "2021-04-16",
        "status": "A",
        "authorized_official_last_name": "MAYES",
        "authorized_official_first_name": "RAVEN",
        "authorized_official_middle_name": "SHENETTE",
        "authorized_official_title_or_position": "HEALTHCARE MANAGER",
        "authorized_official_telephone_number": "352-792-8069",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VISN 8 DIVERSITY TRAINING",
            "identifier": "1324114-11-26-2010",
            "state": "DC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLS (BASIC LIFE SUPPORT) HEALTHCARE PROVIDER",
            "identifier": "1339073-10-01-2009",
            "state": "DC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLS (BASIC LIFE SUPPORT) HEALTHCARE PROVIDER CHALLENGE",
            "identifier": "1339076-10-01-2009",
            "state": "DC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RIGHT SIDED EKG",
            "identifier": "1337502-11-26-2010",
            "state": "DC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VHA PROVIDER PRIVACY TRAINING",
            "identifier": "32432-07-14-2008",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Kwenda, MD
• Samuel Kwiatkowski, DO
• Violet Kyong
• La Lakers
• La Lakers
• Diana Mary La Santa
• Jorelle Laakso, M.S.
• Karen Lynne Laauwe, MD
• Ahmed Lababidi, MD
• Donna Labarge, PHD

• General Acute Care Hospital in Gainesville, FL
• Providers in Gainesville, FL by specialty
• General Acute Care Hospital in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2021; 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.