Active NPI
Leonard Simon, PHD
- Clinical Psychologist
- San Diego, CA
National Provider Identifier
1013090778
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY17791
- Practice address
- 4715 Viewridge Ave
Suite 230
San Diego, CA 92123-1658 - Phone
- (800) 257-8715
- Fax
- (800) 819-1655
- NPI assigned
- Oct 23, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY17791 | CA | Primary |
Addresses
Primary practice location
4715 Viewridge Ave
Suite 230
San Diego, CA 92123-1658
Mailing address
157 North Lucerne Blvd
Los Angeles, CA 90004-3720
Phone (310) 963-0160
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PSY177910 | Medicaid | CA |
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY17791 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161561600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1013090778",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "157 NORTH LUCERNE BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900043720",
"telephone_number": "310-963-0160",
"fax_number": "323-461-0311"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4715 VIEWRIDGE AVE",
"address_2": "SUITE 230",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921231658",
"telephone_number": "800-257-8715",
"fax_number": "800-819-1655"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIMON",
"first_name": "LEONARD",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY17791",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PSY177910",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.