Individual provider Active NPI

Pandora F McDaniel, NP

  • Nurse Practitioner
  • Los Angeles, CA
National Provider Identifier
1972639508
Registry record updated Mar 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN383138 Issued in CA
Practice address
12021 Wilmington Ave
Los Angeles, CA 90059-3019
Phone
(310) 668-4515
Fax
(310) 763-8909
NPI assigned
Feb 26, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X RN383138 CA Primary

Addresses

Primary practice location

12021 Wilmington Ave
Los Angeles, CA 90059-3019

Mailing address

1670 E 120TH St
Module B
Los Angeles, CA 90059-3026
Phone (424) 338-1276

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131107000840 CA Practitioner - Nurse Practitioner 0345475927 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
6543CAMDSpecialist
RN383138CAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
County of Los Angeles CurrentSince Sep 7, 2013 Accepting new patients
County of Los Angeles CurrentSince Sep 7, 2013 Accepting new patients

Locations

1000 S Fremont Ave
Bldg A11
Alhambra, CA 91803
Phone (626) 457-4240

1670 E 120th St
#B
Los Angeles, CA 90059

12021 Wilmington Ave
Los Angeles, CA 90059
Phone (310) 668-4515

1670 E 120th St
Los Angeles, CA 90059
Phone (424) 338-1000

Organizations & group practices 2

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": "1172448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427155200000",
    "number": "1972639508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1670 E 120TH ST",
            "address_2": "MODULE B",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900593026",
            "telephone_number": "424-338-1276",
            "fax_number": "310-223-0192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12021 WILMINGTON AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900593019",
            "telephone_number": "310-668-4515",
            "fax_number": "310-763-8909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCDANIEL",
        "first_name": "PANDORA",
        "middle_name": "F",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-26",
        "last_updated": "2015-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "RN383138",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.