Active NPI
Nicolas Arthur De Souza, PTA
- Physical Therapy Assistant
- Fountain Valley, CA
National Provider Identifier
1376412098
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 54458
- Practice address
- 11420 Warner Ave
Fountain Valley, CA 92708-2529 - Phone
- (657) 204-2959
- NPI assigned
- Oct 31, 2025
- Sex
- Male
- Sole proprietor
- Yes
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 | 54458 | CA | Primary |
Addresses
Primary practice location
11420 Warner Ave
Fountain Valley, CA 92708-2529
Mailing address
11420 Warner Ave
Fountain Valley, CA 92708-2529
Phone (657) 204-2959
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 |
|---|---|---|---|
| 54458 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1761868800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1761868800000",
"number": "1376412098",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11420 WARNER AVE",
"city": "FOUNTAIN VALLEY",
"state": "CA",
"postal_code": "927082529",
"telephone_number": "657-204-2959"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11420 WARNER AVE",
"city": "FOUNTAIN VALLEY",
"state": "CA",
"postal_code": "927082529",
"telephone_number": "657-204-2959"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DE SOUZA",
"first_name": "NICOLAS",
"middle_name": "ARTHUR",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-10-31",
"last_updated": "2025-10-31",
"certification_date": "2025-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Physical Therapy Assistant",
"state": "CA",
"license": "54458",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fountain Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.