Benjamin Mark V Nabong

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

Practice address

13400 Sherman Way
North Hollywood, CA 91605-4415

Phone

(818) 960-5314

NPI assigned

Dec 17, 2019

Last updated

Dec 17, 2019By 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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1576540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576540800000",
    "number": "1578101820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17910 MALDEN ST",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913253818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13400 SHERMAN WAY",
            "city": "NORTH HOLLYWOOD",
            "state": "CA",
            "postal_code": "916054415",
            "telephone_number": "818-960-5314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NABONG",
        "first_name": "BENJAMIN MARK",
        "middle_name": "V",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-12-17",
        "last_updated": "2019-12-17",
        "certification_date": "2019-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "benjaminmnabong@gmail.com",
            "affiliation": "N",
            "endpointDescription": "Email",
            "address_1": "17910 Malden St",
            "city": "Northridge",
            "state": "CA",
            "country_code": "US",
            "postal_code": "913253818",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Physical Therapy Assistant in North Hollywood, CA
• Providers in North Hollywood, CA by specialty
• Physical Therapy Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.