Individual provider Active NPI

Michael Mariano Nabong, MD

  • Student in an Organized Health Care Education/Training Program
  • Surprise, AZ
National Provider Identifier
1659854420
Registry record updated May 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
13995 W Statler Blvd Ste 200
Surprise, AZ 85374-5503
Phone
(602) 478-3100
NPI assigned
Sep 7, 2018
Last updated
May 5, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 5, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X AZ Primary
Behavior Technician 106S00000X 017-LWW AZ

Addresses

Primary practice location

13995 W Statler Blvd Ste 200
Surprise, AZ 85374-5503

Mailing address

13995 W Statler Blvd Ste 200
Surprise, AZ 85374-5503
Phone (602) 478-3100

Other names 1

  • Michael Nabong Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
017-LWWAZMDBehavior Technician

NPI Registry JSON

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

{
    "created_epoch": "1536278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777939200000",
    "number": "1659854420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13995 W STATLER BLVD STE 200",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853745503",
            "telephone_number": "602-478-3100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13995 W STATLER BLVD STE 200",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853745503",
            "telephone_number": "602-478-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARIANO NABONG",
        "first_name": "MICHAEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-09-07",
        "last_updated": "2026-05-05",
        "certification_date": "2026-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "AZ",
            "license": null,
            "primary": true
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "AZ",
            "license": "017-LWW",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHAEL",
            "last_name": "NABONG",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Surprise, AZ

Sources for this page

Verify at the official NPI Registry.