Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
1 | 207P00000X | Emergency Medicine | | | | No |
2 | 207PE0004X | Emergency Medicine | Emergency Medical Services | | | No |
3 | 207PE0005X | Emergency Medicine | Undersea and Hyperbaric Medicine | | | No |
4 | 207PT0002X | Emergency Medicine | Medical Toxicology | | | No |
5 | 207Q00000X | Family Medicine | | | | Yes |
6 | 207QA0000X | Family Medicine | Adolescent Medicine | | | No |
7 | 207QA0401X | Family Medicine | Addiction Medicine | | | No |
8 | 207QA0505X | Family Medicine | Adult Medicine | | | No |
9 | 207QG0300X | Family Medicine | Geriatric Medicine | | | No |
10 | 207QS0010X | Family Medicine | Sports Medicine | | | No |
11 | 261QR0404X | Clinic/Center | Rehabilitation, Cardiac Facilities | | | No |
12 | 363L00000X | Nurse Practitioner | | | | No |
13 | 363LF0000X | Nurse Practitioner | Family | | | No |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
1 | 364823307 | OTHER | | DEPARTMENT OF LABOR |
2 | ZZZP3718Z | OTHER | CALIFORNIA | BLUE SHIELD |
3 | 364823304 | OTHER | | DEPARTMENT OF LABOR |
4 | 2327 | OTHER | CALIFORNIA | CMS GRP |
5 | 364823302 | OTHER | | DEPARTMENT OF LABOR |
6 | ZZZP3718Z | MEDICAID | CALIFORNIA | |
7 | CGP016905 | OTHER | CALIFORNIA | GHPP |
8 | 364823301 | OTHER | | DEPARTMENT OF LABOR |
9 | 364823310 | OTHER | | DEPARTMENT OF LABOR |
10 | 364823305 | OTHER | CALIFORNIA | DEPARTMENT OF LABOR |
11 | 364823306 | OTHER | | DEPARTMENT OF LABOR |
12 | ZZZP3718Z | OTHER | CALIFORNIA | CALOPTIMA |
13 | 364823300 | OTHER | | DEPARTMENT OF LABOR |
14 | 364823303 | OTHER | | DEPARTMENT OF LABOR |
15 | 364823308 | OTHER | | DEPARTEMNT OF LABOR |
16 | CQ4024 | OTHER | CALIFORNIA | RAILROAD MEDICARE GRP |