Active NPI
Majed Andre Nagoulat, D.C.
- Sports Physician Chiropractor
- Riverside, CA
National Provider Identifier
1003206129
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Physician Chiropractor
- License
- 33159
- Practice address
- 5790 Magnolia Ave Ste 104
Riverside, CA 92506-1874 - Phone
- (951) 888-1538
- Fax
- (951) 848-9155
- NPI assigned
- Jan 27, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Physician Chiropractor | 111NS0005X | 33159 | CA | Primary |
Addresses
Primary practice location
5790 Magnolia Ave Ste 104
Riverside, CA 92506-1874
Mailing address
3114 Belvedere Ave
Highland, CA 92346-1614
Phone (714) 717-9596
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150903003022 | CA | Practitioner - Chiropractic | 6204142300 | Practice locations: Riverside, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 33159 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1422316800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1647820800000",
"number": "1003206129",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3114 BELVEDERE AVE",
"city": "HIGHLAND",
"state": "CA",
"postal_code": "923461614",
"telephone_number": "714-717-9596"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5790 MAGNOLIA AVE STE 104",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925061874",
"telephone_number": "951-888-1538",
"fax_number": "951-848-9155"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NAGOULAT",
"first_name": "MAJED",
"middle_name": "ANDRE",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-01-27",
"last_updated": "2022-03-21",
"certification_date": "2022-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "111NS0005X",
"taxonomy_group": "",
"desc": "Chiropractor, Sports Physician",
"state": "CA",
"license": "33159",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.