Active NPI
Ericson Marcial
- Physical Therapist
- Corona, CA
National Provider Identifier
1720691256
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Practice address
- 2489 California Ave
Corona, CA 92881-6600 - Phone
- (951) 268-9697
- NPI assigned
- Aug 25, 2020
- Last updated
- Aug 25, 2020
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | NU | Primary |
Addresses
Primary practice location
2489 California Ave
Corona, CA 92881-6600
Mailing address
8500 Bluffstone CV Ste A201
Austin, TX 78759-7846
Phone (800) 967-2414
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27642 | CA | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1598313600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1598313600000",
"number": "1720691256",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8500 BLUFFSTONE CV STE A201",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787597846",
"telephone_number": "800-967-2414"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2489 CALIFORNIA AVE",
"city": "CORONA",
"state": "CA",
"postal_code": "928816600",
"telephone_number": "951-268-9697"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARCIAL",
"first_name": "ERICSON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-08-25",
"last_updated": "2020-08-25",
"certification_date": "2020-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corona, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 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.