Active NPI
Mirella Squillace, PTA
- Physical Therapy Assistant
- Sherman Oaks, CA
National Provider Identifier
1326514738
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 48873
- Practice address
- 4940 Van Nuys Blvd
Sherman Oaks, CA 91403-1700 - Phone
- (818) 907-0952
- NPI assigned
- Oct 23, 2018
- 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 Therapy Assistant | 225200000X | 48873 | CA | Primary |
Addresses
Primary practice location
4940 Van Nuys Blvd
Sherman Oaks, CA 91403-1700
Mailing address
10620 Balboa Blvd Apt 117
Granada Hills, CA 91344-6333
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 |
|---|---|---|---|
| 48873 | CA | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1540252800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1540252800000",
"number": "1326514738",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10620 BALBOA BLVD APT 117",
"city": "GRANADA HILLS",
"state": "CA",
"postal_code": "913446333"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4940 VAN NUYS BLVD",
"city": "SHERMAN OAKS",
"state": "CA",
"postal_code": "914031700",
"telephone_number": "818-907-0952"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SQUILLACE",
"first_name": "MIRELLA",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-10-23",
"last_updated": "2018-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "CA",
"license": "48873",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sherman Oaks, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.