Active NPI
Michael Mark
- Psychologist
- Manhattan Beach, CA
National Provider Identifier
1558748665
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- Practice address
- 1230 Rosecrans Ave
Suite 300
Manhattan Beach, CA 90266-2477 - Phone
- (424) 456-3020
- Fax
- (424) 456-3021
- NPI assigned
- Apr 28, 2015
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | Primary |
Addresses
Primary practice location
1230 Rosecrans Ave
Suite 300
Manhattan Beach, CA 90266-2477
Mailing address
1230 Rosecrans Ave
Suite 300
Manhattan Beach, CA 90266-2477
Phone (424) 456-3020
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 46-47-90333 | Other | CA | FRANCHISE TAX BOARD |
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": "1430179200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1430179200000",
"number": "1558748665",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1230 ROSECRANS AVE",
"address_2": "SUITE 300",
"city": "MANHATTAN BEACH",
"state": "CA",
"postal_code": "902662477",
"telephone_number": "424-456-3020",
"fax_number": "424-456-3021"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1230 ROSECRANS AVE",
"address_2": "SUITE 300",
"city": "MANHATTAN BEACH",
"state": "CA",
"postal_code": "902662477",
"telephone_number": "424-456-3020",
"fax_number": "424-456-3021"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARK",
"first_name": "MICHAEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-04-28",
"last_updated": "2015-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FRANCHISE TAX BOARD",
"identifier": "46-47-90333",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Manhattan Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.