Active NPI
Selom Gbewonyo
- Student in an Organized Health Care Education/Training Program
- Canoga Park, CA
National Provider Identifier
1972226199
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 21201 Victory Blvd Ste 205
Canoga Park, CA 91303-4056 - Phone
- (888) 428-3223
- NPI assigned
- Sep 22, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | |||
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
21201 Victory Blvd Ste 205
Canoga Park, CA 91303-4056
Mailing address
1731 E 120TH St
Los Angeles, CA 90059-3051
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1663804800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1754524800000",
"number": "1972226199",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1731 E 120TH ST",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900593051"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21201 VICTORY BLVD STE 205",
"city": "CANOGA PARK",
"state": "CA",
"postal_code": "913034056",
"telephone_number": "888-428-3223"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GBEWONYO",
"first_name": "SELOM",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-09-22",
"last_updated": "2025-08-07",
"certification_date": "2025-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Aug 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.