NPI |
1760944391 |
The city name in the location address of the provider being identified. |
Entity Type Code |
1 |
The State code in the location of the provider
being identified. |
Provider Last Name Legal Name |
KLAR |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider First Name |
SOFIA |
The country code in the location address of the provider being identified. |
Provider First Line Business Practice Location Address |
8881 FLETCHER PKWY STE 105 |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address City Name |
LA MESA |
The date the provider was assigned a unique identifier (assigned an NPI). |
Provider Business Practice Location Address State Name |
CA |
The date that a record was last updated or changed. |
Provider Business Practice Location Address Postal Code |
919423132 |
The code designating the provider’s gender if the provider is a person. |
Provider Business Practice Location Address Country Code If outside U S |
US |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider Business Practice Location Address Telephone Number |
6194035700 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Provider Enumeration Date |
4/2/2019 |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Last Update Date |
8/4/2023 |
|
Provider Gender Code |
F |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
Healthcare Provider Taxonomy Code 1 |
390200000X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Healthcare Provider Primary Taxonomy Switch 1 |
N |
|
Healthcare Provider Taxonomy Code 2 |
207V00000X |
|
Provider License Number 2 |
20A21355 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Provider License Number State Code 2 |
CA |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Healthcare Provider Primary Taxonomy Switch 2 |
Y |
|
Is Sole Proprietor |
Y |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
Healthcare Provider Taxonomy Group 2 |
193400000X SINGLE SPECIALTY GROUP |
|
NPI Certification Date |
8/4/2023 |
|