Mario Abrego, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA12832 Issued in CA

Practice address

8225 Long Beach Blvd
South Gate, CA 90280-2010

Phone

(323) 585-2486

Fax

(323) 585-7455

NPI assigned

Jan 18, 2007

Last updated

Jul 9, 2007By the provider in NPPES

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

La Libertad Medical Clinic IncGroup PAC ID 1254368699, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• La Libertad Medical Clinic Inc

  • General Practice Physician
  • South Gate, CA
  • NPI 1295887024
  Medicare reassignment Care Compare group
• La Libertad Medical Clinic Inc.

  • General Practice Physician
  • Walnut Park, CA
  • NPI 1861882946
  NPD

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1215089040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8225 LONG BEACH BLVD",
            "city": "SOUTH GATE",
            "state": "CA",
            "postal_code": "902802010",
            "telephone_number": "323-585-2486",
            "fax_number": "323-585-7455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8225 LONG BEACH BLVD",
            "city": "SOUTH GATE",
            "state": "CA",
            "postal_code": "902802010",
            "telephone_number": "323-585-2486",
            "fax_number": "323-585-7455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABREGO",
        "first_name": "MARIO",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-18",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA12832",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PA12832",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Abner Mahboobian Dental Corporation
• Jose Guadalupe Acevedo, DDS
• Eric Acosta
• Action Medical Supply
• Habib Adib
• Advanced Care Orthopedics

• Physician Assistant in South Gate, CA
• Providers in South Gate, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.