Kerollos Makrmalla, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2000038431 Issued in CA

Practice address

17272 Newhope St
Fountain Valley, CA 92708-4210

Phone

(714) 942-4500

NPI assigned

Mar 14, 2021

Last updated

Mar 14, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: info@fasttwitchsportsmed.com

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

{
    "created_epoch": "1615680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615680000000",
    "number": "1700461480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17272 NEWHOPE ST",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927084210",
            "telephone_number": "714-942-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17272 NEWHOPE ST",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927084210",
            "telephone_number": "714-942-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAKRMALLA",
        "first_name": "KEROLLOS",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-03-14",
        "last_updated": "2021-03-14",
        "certification_date": "2021-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "CA",
            "license": "2000038431",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Info@fasttwitchsportsmed.com",
            "affiliation": "N",
            "address_1": "17272 Newhope St",
            "city": "Fountain Valley",
            "state": "CA",
            "country_code": "US",
            "postal_code": "927084210",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• David T. Mai, M.D.
• Thuy Mai, CAMTC
• Paul Maistros, M.D.
• Amber A Majick, BCBA
• Thanuja Majuran
• Erin Malecha, P.T.
• Kamini Malhotra, MD
• Elisabeth Vanessa Malin, M.D.
• Roland John C Mallari, PT, DPT
• Geremy Mamaclay

• Athletic Trainer in Fountain Valley, CA
• Providers in Fountain Valley, CA by specialty
• Athletic Trainer in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.