Carissa Rae Van Mierlo

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

Practice address

23961 Calle de la Magdalena Ste 119
Laguna Hills, CA 92653-3616

Phone

(949) 837-5111

NPI assigned

Nov 14, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Carissa Rae Tenney Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

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.

• H2Orthopedic Physical Therapy Inc

  • Physical Medicine & Rehabilitation Physician
  • Laguna Hills, CA
  • NPI 1144716531
  NPD

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

{
    "created_epoch": "1636848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636848000000",
    "number": "1972269975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 DAYLILY",
            "city": "RANCHO SANTA MARGARITA",
            "state": "CA",
            "postal_code": "926881442",
            "telephone_number": "949-290-1079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23961 CALLE DE LA MAGDALENA STE 119",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926533616",
            "telephone_number": "949-837-5111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN MIERLO",
        "first_name": "CARISSA",
        "middle_name": "RAE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-14",
        "last_updated": "2021-11-14",
        "certification_date": "2021-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARISSA",
            "last_name": "TENNEY",
            "middle_name": "RAE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Valdemar Ascencio MD Inc.
• Elsa Valdes, M.F.T.
• Mayra A Valdivia
• Isaura Valenzuela
• Dzintris Vallis, MD
• Donna Kaye Van Nieuwenhuyzen
• Andrea Rose Van Ry
• Hohai Truong Van, MD
• Rochelle Ann Vander Tuig
• Kenneth J Vanderbeck, PA-C

• Physical Therapy Assistant in Laguna Hills, CA
• Providers in Laguna Hills, CA by specialty
• Physical Therapy Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.