Individual provider Active NPI

Michael Angelo Ballesteros Abarientos, MSN, RN, PHN, CSR

  • Adult Psychiatric/Mental Health Registered Nurse
  • Santee, CA
National Provider Identifier
1295343184
Registry record updated Jan 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0809X
License
95155191 Issued in CA
Practice address
655 Park Center Dr
Santee, CA 92071-6957
Phone
(619) 596-5500
Fax
(619) 596-5501
NPI assigned
Jul 16, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 22, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 95155191 CA
Adult Psychiatric/Mental Health Registered Nurse 163WP0809X 95155191 CA Primary

Addresses

Primary practice location

655 Park Center Dr
Santee, CA 92071-6957

Mailing address

655 Park Center Dr
Santee, CA 92071-6957
Phone (619) 596-5500

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
Credentials
Master of Science - Nursing, Registered Nurse

State licenses

LicenseStateTypeSpecialty
95155191CAMDRegistered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1594857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705881600000",
    "number": "1295343184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "655 PARK CENTER DR",
            "city": "SANTEE",
            "state": "CA",
            "postal_code": "920716957",
            "telephone_number": "619-596-5500",
            "fax_number": "619-596-5501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 PARK CENTER DR",
            "city": "SANTEE",
            "state": "CA",
            "postal_code": "920716957",
            "telephone_number": "619-596-5500",
            "fax_number": "619-596-5501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABARIENTOS",
        "first_name": "MICHAEL ANGELO",
        "middle_name": "BALLESTEROS",
        "credential": "MSN, RN, PHN, CSR",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-07-16",
        "last_updated": "2024-01-22",
        "certification_date": "2024-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "95155191",
            "primary": false
        },
        {
            "code": "163WP0809X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
            "state": "CA",
            "license": "95155191",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santee, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 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.

Verify at the official NPI Registry.