Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Micah Ebanculla

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1518469378

Micah Ebanculla is a Student in an Organized Health Care Education/Training Program in Long Beach, California. Registered with an NPI since 2018.

In the registry since
2018
Specialties on file
2

Practice location Address checks out

1600 Atlantic Ave
Long Beach, CA 90813-2017
Phone: (562) 591-0581
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Athletic Trainer (primary) Taxonomy 2255A2300X
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1518469378
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMarch 7, 2018
Last updated in NPPESMay 3, 2021
Certification dateApril 22, 2021
Mailing address5503 Pimenta Ave, Lakewood, CA 90712-1743

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