Mathieu Joseph Agbayani Moulic

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

299815 Issued in CA

Practice address

433 N 4TH St Ste 216
Montebello, CA 90640-4309

Phone

(323) 530-0433

Fax

(323) 530-0434

NPI assigned

Feb 4, 2021

Last updated

Feb 4, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Aqe Physical Therapy IncGroup PAC ID 5799040176, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Aqe Physical Therapy, Inc

  • Physical Therapy Clinic/Center
  • Montebello, CA
  • NPI 1366959017
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1612396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612396800000",
    "number": "1548852171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "322 EOLA DR",
            "city": "WALNUT",
            "state": "CA",
            "postal_code": "917892249",
            "telephone_number": "909-859-4410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "433 N 4TH ST STE 216",
            "city": "MONTEBELLO",
            "state": "CA",
            "postal_code": "906404309",
            "telephone_number": "323-530-0433",
            "fax_number": "323-530-0434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOULIC",
        "first_name": "MATHIEU JOSEPH",
        "middle_name": "AGBAYANI",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-02-04",
        "last_updated": "2021-02-04",
        "certification_date": "2021-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "299815",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sandra Montes, M.D.
• Sana Moosaji
• Camilo Jose Morales Acevedo, DDS
• Jorge Luis Moreno, D.O.
• Adriana Pereda Morga, NP
• Moussavian DDS Inc (Sunshine Kids Dental)
• MTB Adult Day Care, Inc. (Montebello Adult Day Health Care Center)
• Mtblo Medical Group Inc
• Multispecialty & Vascular Partners Inc
• Jose Daniel Murga, LMFT 116241

• Physical Therapist in Montebello, CA
• Providers in Montebello, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.