Provider Demographics
NPI:1972904605
Name:RICHARDSON, JANAYIA (NP-C)
Entity Type:Individual
Prefix:MISS
First Name:JANAYIA
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MS
Other - First Name:JANAYIA
Other - Middle Name:
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:5901 GREEN VALLEY CIR STE 405
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6971
Mailing Address - Country:US
Mailing Address - Phone:424-266-7474
Mailing Address - Fax:
Practice Address - Street 1:5901 GREEN VALLEY CIR
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6938
Practice Address - Country:US
Practice Address - Phone:424-266-7474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSF0714898363LF0000X
CA95003300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1972904605Medicaid