KEIKO LILLY MIMURA MSN, APRN, BC, NPI 1932142544 — LOS ANGELES (CA)

NPI 1932142544

13+ Years Experience Individual

KEIKO LILLY MIMURA MSN, APRN, BC

06/13/2006
PROVIDER ENUMERATION DATE
05/21/2013
LAST UPDATE DATE
1932142544
NPI NUMBER

About KEIKO LILLY MIMURA

Sole proprietor? No, Entity Type 1 Provider (Individual) is not a Sole Proprietor.

KEIKO LILLY MIMURA is a provider established in LOS ANGELES, CA. The NPI number of KEIKO LILLY MIMURA is 1932142544 and was assigned on 06/13/2006. The practitioners primary taxonomy code is: 363LG0600X with license number: 14487 CA .

Mailing address

  • City: LOS ANGELES
  • State: CA
  • Postal code: 900493566
  • Phone: 4248328368
  • Fax: 4248328270
  • Address: 11500 NIMITZ AVE

Primary Practice Address

  • Region : LOS ANGELES, CA
  • NPI : 1932142544
  • Phone : 4248328368
  • Fax : 4248328270
  • Postalcode : 900493566
  • Address : 11500 NIMITZ AVE

Provider taxonomy - Nurse Practitioner

  • Taxonomy code: 363LG0600X
  • License number: 14487
  • License state: CA

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Contacts:

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  • KEIKO LILLY MIMURA MSN, APRN, BC
  • Address : 11500 NIMITZ AVE
  • Region : LOS ANGELES, CA
  • NPI : 1932142544
  • Phone : 4248328368
  • Fax : 4248328270
  • Postalcode : 900493566

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address11500 NIMITZ AVE
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 Business Practice Location Address City NameLOS ANGELES
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameCA
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code900493566
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 Telephone Number4248328368
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number4248328270
The fax number associated with the location address of the provider being identified.
NPI1932142544
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1363LG0600X
Provider Enumeration Date06/13/2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated05/21/2013
The date that a record was last updated or changed.
Entity TypeIndividual
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).
Provider Organization Name (Legal Business Name)KEIKO LILLY MIMURA
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address11500 NIMITZ AVE
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 Business Mailing Address City NameLOS ANGELES
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameCA
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 Code900493566
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 Telephone Number4248328368
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 Business Mailing Address Fax Number4248328270
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Healthcare Provider Taxonomy Code #1363LG0600X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Nurse Practitioner
Provider License Number 114487
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1CA
Healthcare Provider Primary Taxonomy Switch 1Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Provider Gender CodeF
  • M - male
  • F - female
Is sole proprietorN
  • X - Not Answered
  • Y - Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor
  • N - No, Entity Type 1 Provider (Individual) is not a Sole Proprietor
X

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