Active NPI
Jenny Mondragon
- Physical Therapist
- Fresno, CA
National Provider Identifier
1306017678
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 30385
- Practice address
- 1221 Fulton Mall
CCS, 2ND Floor
Fresno, CA 93721-1915 - Phone
- (559) 445-3449
- Fax
- (559) 445-3370
- NPI assigned
- Mar 14, 2008
- Sex
- Female
- 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 Therapist | 225100000X | 30385 | CA | Primary |
Addresses
Primary practice location
1221 Fulton Mall
CCS, 2ND Floor
Fresno, CA 93721-1915
Mailing address
1221 Fulton Mall
CCS, 2ND Floor
Fresno, CA 93721-1915
Phone (559) 445-3449
Other names 1
- Ms. Jenny Heath
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 |
|---|---|---|---|
| 30385 | CA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1205452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1235952000000",
"number": "1306017678",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1221 FULTON MALL",
"address_2": "CCS, 2ND FLOOR",
"city": "FRESNO",
"state": "CA",
"postal_code": "937211915",
"telephone_number": "559-445-3449",
"fax_number": "559-445-3370"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1221 FULTON MALL",
"address_2": "CCS, 2ND FLOOR",
"city": "FRESNO",
"state": "CA",
"postal_code": "937211915",
"telephone_number": "559-445-3449",
"fax_number": "559-445-3370"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MONDRAGON",
"first_name": "JENNY",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-03-14",
"last_updated": "2009-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "30385",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JENNY",
"last_name": "HEATH",
"prefix": "MS.",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Fresno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.