Active NPI
Shanassa Nicole Roen-Padilla
- Pediatrics Physician
- Encino, CA
National Provider Identifier
1386063907
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- A159227
- Practice address
- 5353 Balboa Blvd Ste 104
Encino, CA 91316-2858 - Phone
- (818) 789-7181
- NPI assigned
- Apr 10, 2014
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 290447 | NY | |
| Pediatrics Physician | 208000000X | A159227 | CA | Primary |
Addresses
Primary practice location
5353 Balboa Blvd Ste 104
Encino, CA 91316-2858
Mailing address
5353 Balboa Blvd Ste 104
Encino, CA 91316-2858
Phone (818) 789-7181
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A159227 | CA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1397088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1679443200000",
"number": "1386063907",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5353 BALBOA BLVD STE 104",
"city": "ENCINO",
"state": "CA",
"postal_code": "913162858",
"telephone_number": "818-789-7181"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5353 BALBOA BLVD STE 104",
"city": "ENCINO",
"state": "CA",
"postal_code": "913162858",
"telephone_number": "818-789-7181"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROEN-PADILLA",
"first_name": "SHANASSA",
"middle_name": "NICOLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-04-10",
"last_updated": "2023-03-22",
"certification_date": "2023-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NY",
"license": "290447",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "A159227",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Encino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.