Active NPI
Charles Ambrose Banzon, MFT
- Marriage & Family Therapist
- San Diego, CA
National Provider Identifier
1457422966
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 49126
- Practice address
- 2130 National Ave
San Diego, CA 92113-2209 - Phone
- (619) 255-5171
- Fax
- (619) 269-0464
- NPI assigned
- Nov 13, 2006
- 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 |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 49126 | CA | Primary |
Addresses
Primary practice location
2130 National Ave
San Diego, CA 92113-2209
Mailing address
2130 National Ave
San Diego, CA 92113-2209
Phone (619) 255-5171
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 49126 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163376000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724716800000",
"number": "1457422966",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2130 NATIONAL AVE",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921132209",
"telephone_number": "619-255-5171",
"fax_number": "619-269-0464"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2130 NATIONAL AVE",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921132209",
"telephone_number": "619-255-5171",
"fax_number": "619-269-0464"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BANZON",
"first_name": "CHARLES",
"middle_name": "AMBROSE",
"name_prefix": "Mr.",
"credential": "MFT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-13",
"last_updated": "2024-08-27",
"certification_date": "2024-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "49126",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.