Active NPI
Nicolas Russell Mabardy, OTR
- Occupational Therapist
- Los Angeles, CA
National Provider Identifier
1912453374
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT16507
- Practice address
- 1801 Malcolm Ave
Los Angeles, CA 90025-4729 - Phone
- (415) 847-2081
- NPI assigned
- Aug 26, 2016
- 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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OT16507 | CA | Primary |
Addresses
Primary practice location
1801 Malcolm Ave
Los Angeles, CA 90025-4729
Mailing address
1801 Malcolm Ave Apt 2
Los Angeles, CA 90025-4729
Phone (415) 847-2081
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 |
|---|---|---|---|
| OT16507 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1472169600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472169600000",
"number": "1912453374",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1801 MALCOLM AVE APT 2",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900254729",
"telephone_number": "415-847-2081"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1801 MALCOLM AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900254729",
"telephone_number": "415-847-2081"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MABARDY",
"first_name": "NICOLAS",
"middle_name": "RUSSELL",
"name_prefix": "Mr.",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-08-26",
"last_updated": "2016-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CA",
"license": "OT16507",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.