Active NPI
Lissette Areli Maccarone
- Physical Therapist
- Canoga Park, CA
National Provider Identifier
1780800565
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- AT8004
- Practice address
- 22218 Roscoe Blvd
Canoga Park, CA 91304-3343 - Phone
- (310) 435-1540
- NPI assigned
- Apr 18, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 | AT8004 | TX | Primary |
Addresses
Primary practice location
22218 Roscoe Blvd
Canoga Park, CA 91304-3343
Mailing address
22218 Roscoe Blvd
Canoga Park, CA 91304-3343
Phone (310) 435-1540
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AT8004 | Other | CA | STATE PTA LIC |
Other names 1
- Lissette Areli Lopez
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 |
|---|---|---|---|
| AT8004 | TX | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176854400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1780800565",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22218 ROSCOE BLVD",
"city": "CANOGA PARK",
"state": "CA",
"postal_code": "913043343",
"telephone_number": "310-435-1540"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22218 ROSCOE BLVD",
"city": "CANOGA PARK",
"state": "CA",
"postal_code": "913043343",
"telephone_number": "310-435-1540"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACCARONE",
"first_name": "LISSETTE",
"middle_name": "ARELI",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TX",
"license": "AT8004",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE PTA LIC",
"identifier": "AT8004",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "LISSETTE",
"last_name": "LOPEZ",
"middle_name": "ARELI",
"credential": "PTA",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Canoga Park, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.