DR. JAYKUMAR MARADIA (NPI# 1386254134) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386254134 |
| Entity Type | Individual |
| Full Name | DR. JAYKUMAR MARADIA |
| Credential | DNP, PMHNP-BC |
| Practice Address |
15230 Lakeshore Dr Clearlake CA 95422-8107 |
| Mailing Address |
1090 Corbridge Ct Voorhees NJ 08043-1812 |
| Practice Telephone | 7079954545 |
| Mailing Telephone | 8563081432 |
| Enumeration Date | 2020-08-06 |
| Last Update Date | 2020-08-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163WC0200X |
Registered Nurse Specialization: Critical Care Medicine |
95203261 | CA | Nursing Service Providers |
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
95015110 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
15230 LAKESHORE DR |
| City | CLEARLAKE |
| State | CA |
| Zip Code | 95422-8107 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770580268 | Lake Health Services | Pharmacy | 15230 Lakeshore Dr, Clearlake, CA 95422 | 2005-06-30 |
| 1730710617 | Veronica Garcia Arroyo | Community Health Worker | 15230 Lakeshore Dr, Clearlake, CA 95422-8107 | 2020-01-30 |
| 1407494818 | Thomas Pickett | Physician Assistant | 15230 Lakeshore Dr, Clearlake, CA 95422-8107 | 2019-12-16 |
| 1962043174 | Srikanth Mudumba | Pharmacist | 15230 Lakeshore Dr, Clearlake, CA 95422-8107 | 2019-09-30 |
| 1780140046 | Rommel B Gayagoy | Nurse Practitioner | 15230 Lakeshore Dr, Clearlake, CA 95422-8107 | 2019-02-12 |
| 1972084879 | Trina Chung | Dentist | 15230 Lakeshore Dr, Clearlake, CA 95422-8107 | 2018-08-28 |
| 1558849661 | Sonja Derose | Family Medicine | 15230 Lakeshore Dr, Clearlake, CA 95422-8107 | 2018-07-31 |
| 1255838603 | Crystine L'heraux | Nurse Practitioner | 15230 Lakeshore Dr, Clearlake, CA 95422 | 2018-04-11 |
| 1760997951 | Tammy Ezinne Onu | Physician Assistant | 15230 Lakeshore Dr, Clearlake, CA 95422 | 2017-12-09 |
| 1487165817 | Olatunde Omoleye Owoeye | Registered Nurse | 15230 Lakeshore Dr, Clearlake, CA 95422-8107 | 2017-10-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831729201 | Richard Charles Hammond | Counselor | 7000 B South Center Drive, Clearlake, CA 95422 | 2020-01-24 |
| 1609416437 | Junirose Thom | Behavioral Analyst | 4456 Manzanita Avenue Suite 2, Clearlake, CA 95422 | 2020-01-09 |
| 1649781360 | Lake County Office of Education | Local Education Agency (LEA) | 3350 Acacia St, Clearlake, CA 95422 | 2017-10-20 |
| 1083091326 | Noelle Menesini | Physician Assistant | 15230 Lake Shore Drive, Clearlake, CA 95422 | 2015-05-06 |
| 1861820979 | Lake County Office of Education | Local Education Agency (LEA) | 6945 Old Highway 53, Clearlake, CA 95422 | 2013-10-29 |
| 1124469838 | Hassan Sheikh Moghaddas | Surgery | 15332 Lakeshore Dr Ste 101, Clearlake, CA 95422 | 2013-07-10 |
| 1366710279 | Nancy Bylund | Licensed Psychiatric Technician | 7000b South Center Drive, Clearlake, CA 95422 | 2011-12-06 |
| 1699060830 | Planned Parenthood Shasta Pacific | Clinic/Center | 1437 Olympic Drive, Cleaklake, CA 95422 | 2011-06-16 |
| 1164655247 | Hector Lara | Counselor | 14130 Lakeshore Dr., Clearlake, CA 95422 | 2009-08-24 |
| 1518197607 | Vishal V Desai | Pharmacist | 15025, Olympic Drive, Clearlake, CA 95422 | 2009-07-23 |
| Find all providers in zip 95422 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477154573 | Marcus Jang | Nurse Practitioner | 1130 E Colorado St Apt 214, Glendale, CA 91205-2092 | 2020-11-04 |
| 1033718580 | John Sylvanus Allieu Sr. | Nurse Practitioner | 2672 Merganser Ct, Los Banos, CA 93635-9473 | 2020-10-25 |
| 1316546930 | Chika U Oguagha | Nurse Practitioner | 16240 Carmine St, Fontana, CA 92336-1481 | 2020-10-23 |
| 1215534888 | Rosa Maria Aguero | Nurse Practitioner | 9841 Alburtis Ave Unit 29, Santa Fe Springs, CA 90670-3264 | 2020-10-06 |
| 1134726995 | Margarita Maghtesyan | Nurse Practitioner | 20251 Ventura Blvd Ste A, Woodland Hills, CA 91364-2564 | 2020-10-05 |
| 1043827140 | April Lopez Ortiz | Nurse Practitioner | 500 W Ashland Ct, Visalia, CA 93277-6609 | 2020-09-23 |
| 1477167666 | David Joseph Russell | Nurse Practitioner | 17846 Glenwood Rd, Manteca, CA 95336-9521 | 2020-09-03 |
| 1194339382 | Albert Liu | Nurse Practitioner | 43559 Southerland Way, Fremont, CA 94539-5931 | 2020-09-03 |
| 1407469554 | Andre Alexandrian | Nurse Practitioner | 1606 Winona Ave, Burbank, CA 91504-2823 | 2020-08-28 |
| 1790398238 | Heather Richardson | Nurse Practitioner | 112 S Park St Ste 1, San Francisco, CA 94107-1809 | 2020-08-25 |
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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.