MRS. JACQUENE J RICHARDSON (NPI# 1053699850) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053699850 |
| Entity Type | Individual |
| Full Name | MRS. JACQUENE J RICHARDSON |
| Practice Address |
3875 S Western Ave Los Angeles CA 90062-1105 |
| Mailing Address |
498 W. 59th Street San Bernardino CA 92407 |
| Practice Telephone | 3232904373 |
| Mailing Telephone | 3232904373 |
| Enumeration Date | 2011-07-27 |
| Last Update Date | 2011-08-01 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 167G00000X | Licensed Psychiatric Technician | PT36012 | CA | Nursing Service Providers |
| Street Address |
3875 S WESTERN AVE |
| City | LOS ANGELES |
| State | CA |
| Zip Code | 90062-1105 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588648588 | Sarita Mallya | Psychiatry & Neurology | 3875 S Western Ave, Los Angeles, CA 90062-1105 | 2005-12-02 |
| 1811596943 | Katherine Ha | Case Manager/Care Coordinator | 3875 S Western Ave, Los Angeles, CA 90062-1105 | 2020-10-20 |
| 1982239091 | Raul Gordon | Case Manager/Care Coordinator | 3875 S Western Ave, Los Angeles, CA 90062-1105 | 2020-03-09 |
| 1164069787 | Aminta Yesenia Amaya | Case Manager/Care Coordinator | 3875 S Western Ave, Los Angeles, CA 90062-1105 | 2019-12-02 |
| 1740841949 | Alissa Megan Bolen-ramos | Case Manager/Care Coordinator | 3875 S Western Ave, Los Angeles, CA 90062-1105 | 2019-06-27 |
| 1700440039 | Alexis D Medina | Case Manager/Care Coordinator | 3875 S Western Ave, Los Angeles, CA 90062-1105 | 2019-04-22 |
| 1205306230 | Raven C Fleming | Case Manager/Care Coordinator | 3875 S Western Ave, Los Angeles, CA 90062-1105 | 2018-12-03 |
| 1922588227 | Doraluz Rosas | Licensed Vocational Nurse | 3875 S Western Ave, Los Angeles, CA 90062 | 2018-08-16 |
| 1841779535 | Clayton Deewitt Hendrix | Case Manager/Care Coordinator | 3875 S Western Ave, Los Angeles, CA 90062 | 2018-08-13 |
| 1750741070 | Johnny Gutierrez | Case Manager/Care Coordinator | 3875 S Western Ave, Los Angeles, CA 90062 | 2016-02-29 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386298867 | Prompt Healthcare, Inc., A Medical Corporation | Family Medicine | 1972 West 48th Street, #a, Los Angeles, CA 90062 | 2019-08-01 |
| 1083194773 | Day One Detox Center, Inc | Substance Abuse Rehabilitation Facility | 1421 W 46th St, Los Angeles, CA 90062 | 2018-08-21 |
| 1457863706 | The Dream Catcher Foundation, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 1537 W 49th St, Los Angeles, CA 90062 | 2017-10-26 |
| 1639680259 | The Dream Catcher Foundation, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 1762 W 42nd St, Los Angeles, CA 90062 | 2017-10-23 |
| 1033535794 | Trusana Monique Hall | Licensed Vocational Nurse | 4103 S. Halldale Ave, Los Angeles, CA 90062 | 2014-03-05 |
| 1093139644 | Daniel Garcia | Rehabilitation Practitioner | 3381 Western Ave., Los Angeles, CA 90062 | 2014-02-18 |
| 1689003790 | Crystal Vernon | Case Manager/Care Coordinator | 3881 S. Western Avenue, Los Angeles, CA 90062 | 2013-11-08 |
| 1184902934 | Gerry Lynn Lockhart | Case Manager/Care Coordinator | 3881 S Western Avenue, Los Angeles, CA 90062 | 2011-07-28 |
| 1285921692 | Atlantic Recovery Services | Community/Behavioral Health | 1701 Browning Street, Los Angeles, CA 90062 | 2011-07-06 |
| 1174796452 | Tacora Leggett | Counselor | 5311 S Western Avenue, Los Angeles, CA 90062 | 2008-04-08 |
| Find all providers in zip 90062 | ||||
| Taxonomy Code | 167G00000X |
| Grouping | Nursing Service Providers |
| Classification | Licensed Psychiatric Technician |
| An individual licensed by the state board as a Psychiatric Technician based upon completion of a prescribed course of theory and clinical practice, with two thirds of the clinical practice time focused on mental and developmental disorders. The psychiatric technician practices under the direct supervision of a physician, psychologist, registered nurse or other professional to provide care to patients with mental disorders and developmental disabilities. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225635865 | Thalia I. Rochel | Licensed Psychiatric Technician | 450 E Temple St, Los Angeles, CA 90012-4022 | 2020-10-06 |
| 1548776404 | Destiny Ann Galvan | Licensed Psychiatric Technician | 679 New Hamshire Ave, Los Angeles, CA 90005 | 2017-12-14 |
| 1255716098 | Grace Junko Gerardo | Licensed Psychiatric Technician | 226 S. Ave. 52, Los Angeles, CA 90042-4504 | 2015-07-22 |
| 1457786147 | Griselda Flores | Licensed Psychiatric Technician | 2600 Wilshire Blvd, Los Angeles, CA 90057-3400 | 2013-09-12 |
| 1427104728 | Leslie Michelle Blakeney | Licensed Psychiatric Technician | 529 S Maple Ave., Los Angeles, CA 90013 | 2007-01-27 |
| 1467064717 | Jessica Vazquez | Licensed Psychiatric Technician | 679 S New Hampshire Ave Ste 400, Los Angeles, CA 90005-1355 | 2020-08-18 |
| 1558996512 | Yvonne Elisa Molina | Licensed Psychiatric Technician | 470 E 3rd St Ste C, Los Angeles, CA 90013-1630 | 2020-03-10 |
| 1407403439 | Leanna Lynn Ramirez | Licensed Psychiatric Technician | 1711 W Temple St, Los Angeles, CA 90026-5421 | 2019-08-23 |
| 1992357404 | Bernadette Chavez | Licensed Psychiatric Technician | 5201 S Vermont Ave, Los Angeles, CA 90037-3527 | 2019-07-15 |
| 1366000556 | Tyler Shirk | Licensed Psychiatric Technician | 600 St Paul Ave Ste 200, Los Angeles, CA 90017-5686 | 2019-06-03 |
| Find all providers in LOS ANGELES | ||||
| City | LOS ANGELES |
| Zip Code | 90062 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.