Mina Sidarous, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

300536 Issued in CA

Practice address

3828 Schaufele Ave Ste 320
Long Beach, CA 90808-1793

Phone

(562) 348-4588

NPI assigned

Oct 8, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Commons Clinic Medical Group, PCGroup PAC ID 6204221096, 21 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Commons Clinic Medical Group, PC

  • Multi-Specialty Clinic/Center
  • Marina del Rey, CA
  • NPI 1831856640
  Medicare reassignment Care Compare group NPD
• California Luna Care Physical Therapy PC

  • Physical Therapist
  • Los Gatos, CA
  • NPI 1689162166
  Medicare reassignment NPD
• Long Beach - Lakewood Orthopedic Institute

  • Multi-Specialty Clinic/Center
  • Lakewood, CA
  • NPI 1710020755

  Physical Therapist

  Medicare reassignment NPD
• MBST Physical Therapy Inc.

  • Physical Therapist
  • Torrance, CA
  • NPI 1154077329
  NPD Authorized official
• Long Beach - Lakewood Orthopedic Institute

  • Multi-Specialty Clinic/Center
  • Long Beach, CA
  • NPI 1629558713

  Physical Therapist

  NPD

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

{
    "created_epoch": "1538956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664236800000",
    "number": "1851866644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15848",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926595848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3828 SCHAUFELE AVE STE 320",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908081793",
            "telephone_number": "562-348-4588"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1045 W Redondo Beach Blvd",
            "address_purpose": "LOCATION",
            "city": "Gardena",
            "state": "CA",
            "postal_code": "902474128",
            "country_code": "US",
            "telephone_number": "310-768-8193",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIDAROUS",
        "first_name": "MINA",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-10-08",
        "last_updated": "2022-09-27",
        "certification_date": "2021-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "043399-1",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "300536",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "lborthoinstitute.com",
            "affiliation": "N",
            "address_1": "3828 Schaufele Ave Ste 320",
            "city": "Long Beach",
            "state": "CA",
            "country_code": "US",
            "postal_code": "908081793",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Naomi Sianturi
• Nansi Ann Cunanan Sibal, NURSE PRACTITIONER
• Renee Nayal Sibayan, LVN
• Kayla Liana Sibrian
• Alexander Jian Sida, MD
• Zeeshan M Siddiqui, MD
• Arianna Jade Sides
• Carine Sidhom, RD
• Jasmin Sidhu, M.D.
• Mohan S. Sidhu, M.D.

• Physical Therapist in Long Beach, CA
• Providers in Long Beach, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.