Active NPI
Tiffany Juterbock Roberts, PSYD, LMFT 53905
- Marriage & Family Therapist
- San Diego, CA
National Provider Identifier
1003100728
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 53905
- Practice address
- 17140 Bernardo Center Dr
San Diego, CA 92128-2093 - Phone
- (858) 451-5190
- Fax
- (588) 451-5199
- NPI assigned
- May 31, 2011
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 53905 | CA | Primary |
Addresses
Primary practice location
17140 Bernardo Center Dr
San Diego, CA 92128-2093
Mailing address
5400 Kearny Mesa Rd
San Diego, CA 92111-1303
Phone (619) 717-2363
Other names 1
- Tiffany Diane Juterbock
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq | Health Information Exchange (HIE) | Kaiser Permanente |
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 |
|---|---|---|---|
| 53905 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1306800000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1647475200000",
"number": "1003100728",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5400 KEARNY MESA RD",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921111303",
"telephone_number": "619-717-2363"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17140 BERNARDO CENTER DR",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921282093",
"telephone_number": "858-451-5190",
"fax_number": "588-451-5199"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "TIFFANY",
"middle_name": "JUTERBOCK",
"name_prefix": "Dr.",
"credential": "PSYD, LMFT 53905",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-05-31",
"last_updated": "2022-03-17",
"certification_date": "2022-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "53905",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "SOAP",
"endpointTypeDescription": "SOAP URL",
"endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
"affiliation": "Y",
"endpointDescription": "Carequality",
"affiliationName": "Kaiser Permanente",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "C-CDA",
"address_1": "17140 Bernardo Center Dr",
"city": "San Diego",
"state": "CA",
"country_code": "US",
"postal_code": "921282093",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"first_name": "TIFFANY",
"last_name": "JUTERBOCK",
"middle_name": "DIANE",
"credential": "MFT",
"code": "1",
"type": "Former Name"
}
]
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.