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  7. NPI Record 1235294893

EASY CLINIC
Complete NPI Record 1235294893
Nurse Practitioner - Gerontology in Palm Desert, CA

NPI Status: Active since December 26, 2006

Contact Information

43875 WASHINGTON ST
SUITE #C
PALM DESERT, CA
ZIP 92211
Phone: (951) 539-8984

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider Other Organization Name
  6. Provider Other Organization Name Type Code
  7. Provider First Line Business Mailing Address
  8. Provider Second Line Business Mailing Address
  9. Provider Business Mailing Address City Name
  10. Provider Business Mailing Address State Name
  11. Provider Business Mailing Address Postal Code
  12. Provider Business Mailing Address Country Code If outside U S
  13. Provider Business Mailing Address Telephone Number
  14. Provider First Line Business Practice Location Address
  15. Provider Second Line Business Practice Location Address
  16. Provider Business Practice Location Address City Name
  17. Provider Business Practice Location Address State Name
  18. Provider Business Practice Location Address Postal Code
  19. Provider Business Practice Location Address Country Code If outside U S
  20. Provider Business Practice Location Address Telephone Number
  21. Provider Enumeration Date
  22. Last Update Date
  23. Authorized Official Last Name
  24. Authorized Official First Name
  25. Authorized Official Middle Name
  26. Authorized Official Title or Position
  27. Authorized Official Telephone Number
  28. Healthcare Provider Taxonomy Code 1
  29. Provider License Number 1
  30. Provider License Number State Code 1
  31. Healthcare Provider Primary Taxonomy Switch 1
  32. Healthcare Provider Taxonomy Code 2
  33. Provider License Number 2
  34. Provider License Number State Code 2
  35. Healthcare Provider Primary Taxonomy Switch 2
  36. Healthcare Provider Taxonomy Code 3
  37. Provider License Number 3
  38. Provider License Number State Code 3
  39. Healthcare Provider Primary Taxonomy Switch 3
  40. Healthcare Provider Taxonomy Code 4
  41. Provider License Number 4
  42. Provider License Number State Code 4
  43. Healthcare Provider Primary Taxonomy Switch 4
  44. Healthcare Provider Taxonomy Code 5
  45. Provider License Number 5
  46. Provider License Number State Code 5
  47. Healthcare Provider Primary Taxonomy Switch 5
  48. Healthcare Provider Taxonomy Code 6
  49. Provider License Number 6
  50. Provider License Number State Code 6
  51. Healthcare Provider Primary Taxonomy Switch 6
  52. Healthcare Provider Taxonomy Code 7
  53. Provider License Number 7
  54. Provider License Number State Code 7
  55. Healthcare Provider Primary Taxonomy Switch 7
  56. Healthcare Provider Taxonomy Code 8
  57. Provider License Number 8
  58. Provider License Number State Code 8
  59. Healthcare Provider Primary Taxonomy Switch 8
  60. Healthcare Provider Taxonomy Code 9
  61. Provider License Number 9
  62. Provider License Number State Code 9
  63. Healthcare Provider Primary Taxonomy Switch 9
  64. Healthcare Provider Taxonomy Code 10
  65. Provider License Number 10
  66. Provider License Number State Code 10
  67. Healthcare Provider Primary Taxonomy Switch 10
  68. Is Organization Subpart
  69. Parent Organization LBN
  70. Parent Organization TIN
  71. Authorized Official Name Prefix Text
  72. Authorized Official Credential Text
  73. Healthcare Provider Taxonomy Group 1
  74. Healthcare Provider Taxonomy Group 2
  75. Healthcare Provider Taxonomy Group 3
  76. Healthcare Provider Taxonomy Group 4
  77. Healthcare Provider Taxonomy Group 5
  78. Healthcare Provider Taxonomy Group 6
  79. Healthcare Provider Taxonomy Group 7
  80. Healthcare Provider Taxonomy Group 8
  81. Healthcare Provider Taxonomy Group 9
  82. Healthcare Provider Taxonomy Group 10

Complete NPI Dataset

This page represents the complete record for NPI 1235294893. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1235294893
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider Other Organization Name: EASY CLINIC
Other name by which the organization provider is or has been known.
Provider Other Organization Name Type Code: 3
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
Provider First Line Business Mailing Address: 1611 CRENSHAW BLVD
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Second Line Business Mailing Address: SUITE 224
The second line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider second line location address’’.
Provider Business Mailing Address City Name: TORRANCE
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: CA
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 905013123
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 3105395722
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider First Line Business Practice Location Address: 43875 WASHINGTON ST
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location Address: SUITE #C
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: PALM DESERT
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: CA
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 922118249
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 Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 9515398984
The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date: 12/26/2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 12/19/2016
The date that a record was last updated or changed.
Authorized Official Last Name: MOZIA
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: MARTHA
The first name of the authorized official.
Authorized Official Middle Name: N
The middle name of the authorized official.
Authorized Official Title or Position: CEO
The title or position of the authorized official.
Authorized Official Telephone Number: 31053955722
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 163WG0600X
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 License Number 1: 514131
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 1: 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 1: N
Healthcare Provider Taxonomy Code 2: 163WR0006X
Provider License Number 2: 514131
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: N
Healthcare Provider Taxonomy Code 3: 101YM0800X
Provider License Number 3: 514131
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 3: 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 3: N
Healthcare Provider Taxonomy Code 4: 363LP0808X
Provider License Number 4: 11282
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 4: 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 4: N
Healthcare Provider Taxonomy Code 5: 163WC0400X
Provider License Number 5: 514131
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 5: 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 5: N
Healthcare Provider Taxonomy Code 6: 364SC2300X
Provider License Number 6: 11282
Provider License Number State Code 6: CA
Healthcare Provider Primary Taxonomy Switch 6: N
Healthcare Provider Taxonomy Code 7: 163WP0808X
Provider License Number 7: 514131
Provider License Number State Code 7: CA
Healthcare Provider Primary Taxonomy Switch 7: N
Healthcare Provider Taxonomy Code 8: 171M00000X
Provider License Number 8: 95090658
Provider License Number State Code 8: CA
Healthcare Provider Primary Taxonomy Switch 8: N
Healthcare Provider Taxonomy Code 9: 163WG0000X
Provider License Number 9: 11282
Provider License Number State Code 9: CA
Healthcare Provider Primary Taxonomy Switch 9: N
Healthcare Provider Taxonomy Code 10: 363LG0600X
Provider License Number 10: G1112004
Provider License Number State Code 10: CA
Healthcare Provider Primary Taxonomy Switch 10: Y
Is Organization Subpart: Y
Parent Organization LBN: PREVENTIVE HEALTH ESSENTIALS INC
Parent Organization TIN: UNAVAIL
Authorized Official Name Prefix Text: DR.
Authorized Official Credential Text: DNP,GNP/FNP, PMH-BC
Healthcare Provider Taxonomy Group 1: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
Healthcare Provider Taxonomy Group 2: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
Healthcare Provider Taxonomy Group 3: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
Healthcare Provider Taxonomy Group 4: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
Healthcare Provider Taxonomy Group 5: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
Healthcare Provider Taxonomy Group 6: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
Healthcare Provider Taxonomy Group 7: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
Healthcare Provider Taxonomy Group 8: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
Healthcare Provider Taxonomy Group 9: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
Healthcare Provider Taxonomy Group 10: 193400000X MULTIPLE SINGLE SPECIALTY GROUP