Active NPI
Vincent Zandrew L Ilagan
- Physical Therapy Assistant
- Granada Hills, CA
National Provider Identifier
1174345144
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 50223
- Practice address
- 17166 Rinaldi St.
Granada Hills, CA 91344 - Phone
- (760) 887-8874
- NPI assigned
- Oct 30, 2024
- Sex
- Male
- Sole proprietor
- No
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 | 50223 | CA | Primary |
Addresses
Primary practice location
17166 Rinaldi St.
Granada Hills, CA 91344
Mailing address
8550 Balboa Blvd
Suite 242
Northridge, CA 91325
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 |
|---|---|---|---|
| 50223 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1730246400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730246400000",
"number": "1174345144",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8550 BALBOA BLVD",
"address_2": "SUITE 242",
"city": "NORTHRIDGE",
"state": "CA",
"postal_code": "91325"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17166 RINALDI ST.",
"city": "GRANADA HILLS",
"state": "CA",
"postal_code": "91344",
"telephone_number": "760-887-8874"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ILAGAN",
"first_name": "VINCENT ZANDREW",
"middle_name": "L",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-10-30",
"last_updated": "2024-10-30",
"certification_date": "2024-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "CA",
"license": "50223",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Granada Hills, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.