Active NPI
Anthony Banaag
- Athletic Trainer
- San Diego, CA
National Provider Identifier
1497220792
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 080802105
- Practice address
- 2450 Craven St BLDG 3300
San Diego, CA 92136-5599 - Phone
- (619) 556-7931
- NPI assigned
- Oct 12, 2018
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 080802105 | CA | Primary |
Addresses
Primary practice location
2450 Craven St BLDG 3300
San Diego, CA 92136-5599
Mailing address
10647 Carmel Mountain Rd
San Diego, CA 92129-2034
Phone (619) 316-2593
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 |
|---|---|---|---|
| 080802105 | CA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1539302400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1539302400000",
"number": "1497220792",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10647 CARMEL MOUNTAIN RD",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921292034",
"telephone_number": "619-316-2593"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2450 CRAVEN ST BLDG 3300",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921365599",
"telephone_number": "619-556-7931"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BANAAG",
"first_name": "ANTHONY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-10-12",
"last_updated": "2018-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "CA",
"license": "080802105",
"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 Oct 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.