Mark Ebalo, PP-2

Primary specialty

Social WorkerTaxonomy code 104100000X

Practice address

1356 Ridder Park Dr
San Jose, CA 95131-2313

Phone

(669) 205-2512

NPI assigned

Nov 13, 2017

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1510531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687219200000",
    "number": "1205349255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1356 RIDDER PARK DR",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951312313",
            "telephone_number": "669-205-2512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1356 RIDDER PARK DR",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951312313",
            "telephone_number": "669-205-2512"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "185 Martinvale Ln",
            "address_purpose": "LOCATION",
            "city": "San Jose",
            "state": "CA",
            "postal_code": "951191319",
            "country_code": "US",
            "telephone_number": "408-207-0070",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1360 E Lassen Ave",
            "address_purpose": "LOCATION",
            "city": "Chico",
            "state": "CA",
            "postal_code": "95973",
            "country_code": "US",
            "telephone_number": "530-267-1766",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EBALO",
        "first_name": "MARK",
        "credential": "PP-2",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-11-13",
        "last_updated": "2023-06-20",
        "certification_date": "2023-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Loma Eaves
• Ebadat Chiropractic Inc,
• Ebadat Chiropractic Inc.
• Asghar Jay Ebadat, D.C.
• Laleh Ebadat
• Jordan Alexis Ebarle
• Jackie Ann Ebbert
• David Eberhardt
• Veronica Anne Ebora
• Jalaledin Ebrahim, LMFT

• Social Worker in San Jose, CA
• Providers in San Jose, CA by specialty
• Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 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.

Verify at the official NPI Registry.