Active NPI
Mark Pushin
- Psychiatry Physician
- Los Angeles, CA
National Provider Identifier
1275659278
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- A53464
- Practice address
- 4211 Avalon Blvd
Los Angeles, CA 90011-5622 - Phone
- (323) 432-5185
- NPI assigned
- Mar 21, 2007
- Last updated
- Jun 14, 2013
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | A53464 | CA | Primary |
Addresses
Primary practice location
4211 Avalon Blvd
Los Angeles, CA 90011-5622
Mailing address
PO Box 480978
Los Angeles, CA 90048-9578
Phone (323) 719-2019
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 53464 | CA | MD | Marriage & Family Therapist |
| A53464 | CA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174435200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1371168000000",
"number": "1275659278",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 480978",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900489578",
"telephone_number": "323-719-2019"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4211 AVALON BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900115622",
"telephone_number": "323-432-5185"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUSHIN",
"first_name": "MARK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-21",
"last_updated": "2013-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "A53464",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.