Active NPI
Domilou Bong Unido, PTA
- Physical Therapy Assistant
- Glendale, CA
National Provider Identifier
1386091262
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- AT 8644
- Practice address
- 1416 E Windsor Rd
Glendale, CA 91205-2755 - Phone
- (818) 441-8343
- NPI assigned
- May 19, 2016
- 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 | AT 8644 | CA | Primary |
Addresses
Primary practice location
1416 E Windsor Rd
Glendale, CA 91205-2755
Mailing address
1416 E Windsor Rd
Glendale, CA 91205-2755
Phone (818) 441-8343
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 |
|---|---|---|---|
| AT 8644 | CA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1463616000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1463616000000",
"number": "1386091262",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1416 E WINDSOR RD",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912052755",
"telephone_number": "818-441-8343"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1416 E WINDSOR RD",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912052755",
"telephone_number": "818-441-8343"
}
],
"practiceLocations": [],
"basic": {
"last_name": "UNIDO",
"first_name": "DOMILOU BONG",
"name_prefix": "Mr.",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-05-19",
"last_updated": "2016-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "CA",
"license": "AT 8644",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glendale, CA
- Unbelievable Home Health Inc
- Unichoice, Inc
- Unichoice, Inc (glenmed pharmacy)
- Unicorn Home Health, Inc.
- Unicorn Transport Inc.
- Unik Home Health Care Services Inc
- Unimed Home Health Inc
- United Community Services
- United Hospice Services, Inc.
- United Medical Imaging Healthcare, Inc. (United Medical Imaging of Glendale)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.