Active NPI
Vicki Kodad
- Counselor
- Moreno Valley, CA
National Provider Identifier
1023292158
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- CAADE051086
- Practice address
- 12712 Heacock St
Suite 6
Moreno Valley, CA 92553-3037 - Phone
- (951) 243-5576
- NPI assigned
- Dec 26, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | CAADE051086 | CA | Primary |
| Mental Health Counselor | 101YM0800X | 101YM0800X | CA |
Addresses
Primary practice location
12712 Heacock St
Suite 6
Moreno Valley, CA 92553-3037
Mailing address
12712 Heacock St
Suite 6
Moreno Valley, CA 92553-3037
Phone (951) 243-5576
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 |
|---|---|---|---|
| 101YM0800X | CA | MD | Counselor |
| CAADE051086 | CA | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1198627200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1213574400000",
"number": "1023292158",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12712 HEACOCK ST",
"address_2": "SUITE 6",
"city": "MORENO VALLEY",
"state": "CA",
"postal_code": "925533037",
"telephone_number": "951-243-5576"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12712 HEACOCK ST",
"address_2": "SUITE 6",
"city": "MORENO VALLEY",
"state": "CA",
"postal_code": "925533037",
"telephone_number": "951-243-5576"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KODAD",
"first_name": "VICKI",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-12-26",
"last_updated": "2008-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "CA",
"license": "CAADE051086",
"primary": true
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "101YM0800X",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moreno Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.