Mark Izquierdo-Gallegos

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

93163 Issued in CA

Practice address

1359 N Grand Ave
Covina, CA 91724-1016

Phone

(626) 430-2900

NPI assigned

Sep 21, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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 and National Provider Directory roles.

• Los Angeles County Department of Mental Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Los Angeles, CA
  • NPI 1083633929
  Medicare reassignment NPD
• Sud Specialty Group - Ca

  • Addiction Medicine (Psychiatry & Neurology) Physician
  • Santa Clara, CA
  • NPI 1972138238

  Clinical

  Medicare reassignment NPD
• Los Angeles County Department of Mental Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Arcadia, CA
  • NPI 1902676075
  NPD
• Los Angeles County Department of Mental Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Covina, CA
  • NPI 1912381484
  NPD

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

{
    "created_epoch": "1442793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575849600000",
    "number": "1659740520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1359 N GRAND AVE",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917241016",
            "telephone_number": "626-430-2900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1359 N GRAND AVE",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917241016",
            "telephone_number": "626-430-2900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IZQUIERDO-GALLEGOS",
        "first_name": "MARK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-09-21",
        "last_updated": "2019-12-09",
        "certification_date": "2019-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "71573",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "93163",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Camille Iverson
• Leilani Iwankiw
• Jose Antonio Ixta-Matute
• Adelina Ixta
• Kristine Veronica Izedi, MS
• J&K Orthopedics Inc
• Teneil Patricia Jacks
• Curtis Jackson
• Erika Dawn Jackson
• Isaiah J Jackson

• Clinical Social Worker in Covina, CA
• Providers in Covina, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2019; 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.

Verify at the official NPI Registry.