Active NPI
Mark Anthony M Inocencio, P.T.
- Physical Therapist
- Chino, CA
National Provider Identifier
1700102589
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 35671
- Practice address
- 13038 Melon Ave
Chino, CA 91710-8123 - Phone
- (808) 557-1894
- NPI assigned
- Apr 19, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 35671 | CA | Primary |
| Physical Therapist | 225100000X | 2003029517 | MO | |
| Physical Therapist | 225100000X | 070015600 | IL |
Addresses
Primary practice location
13038 Melon Ave
Chino, CA 91710-8123
Mailing address
13038 Melon Ave
Chino, CA 91710-8123
Phone (808) 557-1894
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 |
|---|---|---|---|
| 35671 | CA | MD | Pharmacist |
| 070015600 | IL | MD | Physical Therapist |
| 2003029517 | MO | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1271635200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1271635200000",
"number": "1700102589",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13038 MELON AVE",
"city": "CHINO",
"state": "CA",
"postal_code": "917108123",
"telephone_number": "808-557-1894"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13038 MELON AVE",
"city": "CHINO",
"state": "CA",
"postal_code": "917108123",
"telephone_number": "808-557-1894"
}
],
"practiceLocations": [],
"basic": {
"last_name": "INOCENCIO",
"first_name": "MARK ANTHONY",
"middle_name": "M",
"name_prefix": "Mr.",
"credential": "P.T.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-04-19",
"last_updated": "2010-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "35671",
"primary": true
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MO",
"license": "2003029517",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070015600",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chino, CA
- Inland Psychiatric Medical Group, Inc
- Inland Psychiatry and Sleep Inc
- Inland Valley Psychological and Assessment Services Inc.
- Inland Valley Rehabilitation Center of Chino Inc.
- Robert A Innocenzi, D.O.
- Intercommunity Oncology of Chino Hills Apc Inc
- Interim Homestyle Services, Inc.
- Damon Iosua Garcia
- Ipharmacy Inc
- Jordan Elizabeth Dale Ireland, MFTI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.