Active NPI
Jack Mark, CPO
- Prosthetist
- Los Angeles, CA
National Provider Identifier
1699228619
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetist
- License
- CPO01066
- Practice address
- 3160 Geneva St
Los Angeles, CA 90020-1117 - Phone
- (213) 368-3374
- NPI assigned
- Jul 26, 2016
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Orthotist | 222Z00000X | CPO01066 | DE | |
| Prosthetist | 224P00000X | CPO01066 | DE | Primary |
Addresses
Primary practice location
3160 Geneva St
Los Angeles, CA 90020-1117
Mailing address
3160 Geneva St
Los Angeles, CA 90020-1117
Phone (213) 368-3374
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 |
|---|---|---|---|
| CPO01066 | DE | MD | Prosthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1469491200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1469491200000",
"number": "1699228619",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3160 GENEVA ST",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900201117",
"telephone_number": "213-368-3374"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3160 GENEVA ST",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900201117",
"telephone_number": "213-368-3374"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARK",
"first_name": "JACK",
"name_prefix": "Mr.",
"credential": "CPO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-07-26",
"last_updated": "2016-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "222Z00000X",
"taxonomy_group": "",
"desc": "Orthotist",
"state": "DE",
"license": "CPO01066",
"primary": false
},
{
"code": "224P00000X",
"taxonomy_group": "",
"desc": "Prosthetist",
"state": "DE",
"license": "CPO01066",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.