Active NPI
Bernard Alcoba Quismundo, PA-C
- Physician Assistant
- Long Beach, CA
National Provider Identifier
1528287588
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 14509
- Practice address
- 2600 Redondo Ave
Suite 501
Long Beach, CA 90806-2325 - Phone
- (562) 933-0085
- Fax
- (562) 933-0088
- NPI assigned
- Apr 25, 2007
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 14509 | CA | Primary |
Addresses
Primary practice location
2600 Redondo Ave
Suite 501
Long Beach, CA 90806-2325
Mailing address
2600 Redondo Ave
Suite 501
Long Beach, CA 90806-2325
Phone (562) 933-0085
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 14509 | Other | CA | PA-C LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190925003692 | CA | Order and Referring Only - Physician Assistant | 3274514088 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14509 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177459200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1528287588",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2600 REDONDO AVE",
"address_2": "SUITE 501",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908062325",
"telephone_number": "562-933-0085",
"fax_number": "562-933-0088"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2600 REDONDO AVE",
"address_2": "SUITE 501",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908062325",
"telephone_number": "562-933-0085",
"fax_number": "562-933-0088"
}
],
"practiceLocations": [],
"basic": {
"last_name": "QUISMUNDO",
"first_name": "BERNARD",
"middle_name": "ALCOBA",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "14509",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PA-C LICENSE",
"identifier": "14509",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Long Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.