Active NPI
Shadi Jahangard-Mahboob, PT, DPT
- Physical Therapist
- Montebello, CA
National Provider Identifier
1679100036
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT298045
- Practice address
- 273 E Beverly Blvd
Montebello, CA 90640-3775 - Phone
- (323) 724-5100
- NPI assigned
- Mar 25, 2020
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT298045 | CA | Primary |
Addresses
Primary practice location
273 E Beverly Blvd
Montebello, CA 90640-3775
Mailing address
273 E Beverly Blvd
Montebello, CA 90640-3775
Phone (323) 724-5100
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT298045 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1585094400000",
"number": "1679100036",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "273 E BEVERLY BLVD",
"city": "MONTEBELLO",
"state": "CA",
"postal_code": "906403775",
"telephone_number": "323-724-5100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "273 E BEVERLY BLVD",
"city": "MONTEBELLO",
"state": "CA",
"postal_code": "906403775",
"telephone_number": "323-724-5100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JAHANGARD-MAHBOOB",
"first_name": "SHADI",
"credential": "PT, DPT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-03-25",
"last_updated": "2020-03-25",
"certification_date": "2020-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT298045",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Montebello, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.