Active NPI
Jonathan Rex Carlos, PTA
- Physical Therapy Assistant
- Fountain Valley, CA
National Provider Identifier
1033815949
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2173815
- Practice address
- 10670 Slater Ave
Fountain Valley, CA 92708-4806 - Phone
- (714) 586-2498
- NPI assigned
- Feb 1, 2023
- 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 |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 2173815 | TX | Primary |
Addresses
Primary practice location
10670 Slater Ave
Fountain Valley, CA 92708-4806
Mailing address
10670 Slater Ave
Fountain Valley, CA 92708-4806
Phone (714) 586-2498
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2173815 | Other | TX | TEXAS BOARD OF PHYSICAL THERAPY |
| 2173815 | Other | TX | TEXAS BOARD OF PHYICAL THERAPY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2173815 | TX | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1675209600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675209600000",
"number": "1033815949",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10670 SLATER AVE",
"city": "FOUNTAIN VALLEY",
"state": "CA",
"postal_code": "927084806",
"telephone_number": "714-586-2498"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10670 SLATER AVE",
"city": "FOUNTAIN VALLEY",
"state": "CA",
"postal_code": "927084806",
"telephone_number": "714-586-2498"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARLOS",
"first_name": "JONATHAN REX",
"name_prefix": "Mr.",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-02-01",
"last_updated": "2023-02-01",
"certification_date": "2023-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "TX",
"license": "2173815",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TEXAS BOARD OF PHYSICAL THERAPY",
"identifier": "2173815",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TEXAS BOARD OF PHYICAL THERAPY",
"identifier": "2173815",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fountain Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.