Active NPI
Isata S Mbawa, LPT
- Licensed Psychiatric Technician
- San Jose, CA
National Provider Identifier
1346754025
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Psychiatric Technician
- License
- 37848
- Practice address
- 4987 Speak LN
San Jose, CA 95118-2767 - Phone
- (408) 417-1164
- NPI assigned
- Nov 16, 2017
- Last updated
- Nov 16, 2017
- 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 |
|---|---|---|---|---|
| Licensed Psychiatric Technician | 167G00000X | 37848 | CA | Primary |
Addresses
Primary practice location
4987 Speak LN
San Jose, CA 95118-2767
Mailing address
4987 Speak LN
San Jose, CA 95118-2767
Phone (408) 417-1164
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 16127819 | Other | CA | KAISER PERMANENTE |
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 |
|---|---|---|---|
| 37848 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1510790400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1510790400000",
"number": "1346754025",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4987 SPEAK LN",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951182767",
"telephone_number": "408-417-1164"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4987 SPEAK LN",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951182767",
"telephone_number": "408-417-1164"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MBAWA",
"first_name": "ISATA",
"middle_name": "S",
"name_prefix": "Ms.",
"credential": "LPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-11-16",
"last_updated": "2017-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "167G00000X",
"taxonomy_group": "",
"desc": "Licensed Psychiatric Technician",
"state": "CA",
"license": "37848",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KAISER PERMANENTE",
"identifier": "16127819",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.