SUSIATI GUNAWAN (NPI# 1598133357) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1598133357 |
| Entity Type | Individual |
| Full Name | SUSIATI GUNAWAN |
| Credential | LVN |
| Practice Address |
2401 Venier Way Costa Mesa CA 92627-1441 |
| Practice Telephone | 7142608386 |
| Mailing Telephone | 7142608386 |
| Enumeration Date | 2015-09-10 |
| Last Update Date | 2015-09-10 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 164X00000X | Licensed Vocational Nurse | VN257822 | CA | Nursing Service Providers |
| Street Address |
2401 VENIER WAY |
| City | COSTA MESA |
| State | CA |
| Zip Code | 92627-1441 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902407174 | Ryan Allen Merrell | Technician | 313 E. 17th Pl #l Costa Mesa, Costa Mesa, CA 92627 | 2020-11-04 |
| 1245703412 | Allure Transportation | Non-emergency Medical Transport (VAN) | 1835 Newport Blvd Ste 109 #110, Costa Mesa, CA 92627 | 2019-01-09 |
| 1750857686 | Living Success Center | Marriage & Family Therapist | 445 E. 17th Street, Suites D & E, Costa Mesa, CA 92627 | 2018-10-18 |
| 1790298909 | Akua Behavioral Health, Inc | Substance Abuse Rehabilitation Facility | 319-a University Drive, Costa Mesa, CA 92627 | 2017-11-09 |
| 1679086862 | Akua Behavioral Health, Inc | Substance Abuse Rehabilitation Facility | 319-b University Drive, Costa Mesa, CA 92627 | 2017-11-09 |
| 1245759018 | Surgical Assistant Associates | Clinic/Center | 186 E. 16th Street, Suite C, Costa Mesa, CA 92627 | 2017-09-13 |
| 1366962334 | Guadalupe A. Mejia Dental Corp. | Dentist | 700 W 19th St., Suite C, Costa Mesa, CA 92627 | 2017-06-21 |
| 1386189033 | Jian Yi Ye | Acupuncturist | 2488 Newport Blvd Ste B1, Costa Mesa, CA 92627 | 2017-01-04 |
| 1144764606 | Michele Marie Patton | Dental Hygienist | 2220 Fairview Rd., Costa Mesa, CA 92627 | 2016-12-18 |
| 1881148500 | Valerie Nguyen | Pharmacist | 1835 Newport Blvd # C, Costa Mesa, CA 92627 | 2016-08-10 |
| Find all providers in zip 92627 | ||||
| Taxonomy Code | 164X00000X |
| Grouping | Nursing Service Providers |
| Classification | Licensed Vocational Nurse |
| An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. [An alternate term for licensed practical nurse arising from difference in occupational titles between states and post-high school training programs and institutions.] Requirements for education, experience, licensure, and job responsibilities vary among the states. |
| Notes: Source: Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417556374 | Rainville Love Dela Salde | Licensed Vocational Nurse | 1300 Adams Ave Apt 12a, Costa Mesa, CA 92626-8315 | 2020-10-21 |
| 1952940462 | Jan Maverick Santos Santiago | Licensed Vocational Nurse | 1003 Concord St, Costa Mesa, CA 92626-2807 | 2019-12-31 |
| 1679842009 | Cimar Scaff | Licensed Vocational Nurse | 555 Paularino Ave Apt C104, Costa Mesa, CA 92626-3254 | 2011-12-14 |
| 1457629180 | Jayzon Beleno Banez | Licensed Vocational Nurse | 2775 Mesa Verde Dr E Apt H207, Costa Mesa, CA 92626-4985 | 2011-12-08 |
| 1811148497 | John Allen Hough | Licensed Vocational Nurse | 2955 Fairview Rd, #314, Costa Mesa, CA 92626-4117 | 2008-10-01 |
| 1770100364 | Debra Ruiz Aquino | Licensed Vocational Nurse | 301 Victoria St, Costa Mesa, CA 92627-1995 | 2020-06-29 |
| 1548809056 | Jessica Lynne Miller | Licensed Vocational Nurse | 301 Victoria St, Costa Mesa, CA 92627-1995 | 2019-12-31 |
| 1326683269 | Alissa Robles Polehonki | Licensed Vocational Nurse | 985 Victoria St, Costa Mesa, CA 92627-4067 | 2019-11-14 |
| 1164827911 | Jeong Oh | Licensed Vocational Nurse | 275 Baker St E, Costa Mesa, CA 92626-4566 | 2014-10-22 |
| 1568876209 | Nicole Ganci | Licensed Vocational Nurse | 1550 Superior Ave, Costa Mesa, CA 92627-3653 | 2014-06-19 |
| Find all providers in COSTA MESA | ||||
| City | COSTA MESA |
| Zip Code | 92627 |
Please comment or provide details below to improve the information on SUSIATI GUNAWAN.
| 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.