Active NPI
Jessica Nicole Bonoan
- Physical Therapy Assistant
- Granada Hills, CA
National Provider Identifier
1952015927
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 52133
- Practice address
- 11022 Balboa Blvd
Granada Hills, CA 91344-5007 - Phone
- (818) 217-4482
- NPI assigned
- Jan 13, 2023
- 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 Therapy Assistant | 225200000X | 52133 | CA | Primary |
Addresses
Primary practice location
11022 Balboa Blvd
Granada Hills, CA 91344-5007
Mailing address
9752 Marklein Ave
North Hills, CA 91343-2129
Phone (510) 331-6145
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 |
|---|---|---|---|
| 52133 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Theracare Physical Therapy Inc | Single Specialty | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1673568000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1673568000000",
"number": "1952015927",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9752 MARKLEIN AVE",
"city": "NORTH HILLS",
"state": "CA",
"postal_code": "913432129",
"telephone_number": "510-331-6145"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11022 BALBOA BLVD",
"city": "GRANADA HILLS",
"state": "CA",
"postal_code": "913445007",
"telephone_number": "818-217-4482"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BONOAN",
"first_name": "JESSICA",
"middle_name": "NICOLE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-01-13",
"last_updated": "2023-01-13",
"certification_date": "2023-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Physical Therapy Assistant",
"state": "CA",
"license": "52133",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Granada Hills, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.