Active NPI
Sydney Mayumi Cabellon, DPT
- Physical Therapist
- Costa Mesa, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Practice address
- 2777 Bristol St Ste B
Costa Mesa, CA 92626-5997 - Phone
- (949) 250-1112
- NPI assigned
- Feb 17, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | |||
| Physical Therapist | 225100000X | CA | Primary |
Addresses
Primary practice location
2777 Bristol St Ste B
Costa Mesa, CA 92626-5997
Mailing address
2777 Bristol St Ste B
Costa Mesa, CA 92626-5997
Phone (949) 250-1112
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 303765 | Other | CA | PTBC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2777 Bristol St
Suite B
Costa Mesa, CA 92626-5997
Phone (949) 250-1112
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prosport Physical Therapy Professionals Inc | Physical Therapist | Current | Accepting new patients |
| Prosport Physical Therapy Professionals Inc | Physical Therapist | Current | Accepting new patients |
| Prosport Physical Therapy Professionals Inc | Physical Therapist | Current | Accepting new patients |
Locations
2777 Bristol St
Ste B
Costa Mesa, CA 92626
Phone (949) 250-1112
26672 Portola Pkwy
Ste 116
Foothill Rnch, CA 92610
Phone (714) 450-4999
Organizations & group practices 3
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.
-
- Physical Therapy Clinic/Center
- Costa Mesa, CA
- NPI 1073170437
Physical Therapist
-
dba Palos Verdes Physical Therapy
- Physical Therapist
- Rancho Palos Verdes, CA
- NPI 1487648341
-
- Physical Therapy Clinic/Center
- Mission Viejo, CA
- NPI 1922031731
Physical Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1676592000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1685404800000",
"number": "1689372781",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2777 BRISTOL ST STE B",
"city": "COSTA MESA",
"state": "CA",
"postal_code": "926265997",
"telephone_number": "949-250-1112"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2777 BRISTOL ST STE B",
"city": "COSTA MESA",
"state": "CA",
"postal_code": "926265997",
"telephone_number": "949-250-1112"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CABELLON",
"first_name": "SYDNEY",
"middle_name": "MAYUMI",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-02-17",
"last_updated": "2023-05-30",
"certification_date": "2023-05-30",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": null,
"license": null,
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PTBC",
"identifier": "303765",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Costa Mesa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.