Active NPI
Anthony Mangrobang
- Behavior Analyst
- San Diego, CA
National Provider Identifier
1508679234
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1-24-78623
- Practice address
- 3111 Camino del Rio N Ste 500
San Diego, CA 92108-5725 - Phone
- (185) 824-4517
- NPI assigned
- Jan 28, 2025
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 1-24-78623 | CA | Primary |
Addresses
Primary practice location
3111 Camino del Rio N Ste 500
San Diego, CA 92108-5725
Mailing address
100 N. PCH Hwy, Suite 1400
El Segundo, CA 90245
Phone (310) 856-0800
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1738022400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1738022400000",
"number": "1508679234",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 N. PCH HWY, SUITE 1400",
"city": "EL SEGUNDO",
"state": "CA",
"postal_code": "90245",
"telephone_number": "310-856-0800",
"fax_number": "855-568-2494"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3111 CAMINO DEL RIO N STE 500",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921085725",
"telephone_number": "185-824-4517"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANGROBANG",
"first_name": "ANTHONY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-01-28",
"last_updated": "2025-01-28",
"certification_date": "2025-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "CA",
"license": "1-24-78623",
"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 Jan 28, 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.