Active NPI
Diane K. Pendragon, PSY.D.
- Clinical Psychologist
- San Diego, CA
National Provider Identifier
1033316468
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY20239
- Practice address
- 4452 Park Blvd
Suite 101
San Diego, CA 92116-4051 - Phone
- (866) 842-8927
- Fax
- (866) 842-8927
- NPI assigned
- Jun 29, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY20239 | CA | Primary |
Addresses
Primary practice location
4452 Park Blvd
Suite 101
San Diego, CA 92116-4051
Mailing address
4452 Park Blvd
Suite 101
San Diego, CA 92116-4051
Phone (866) 842-8927
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY20239 | CA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Marcie I. Goldman, PH.D, Psychologist, Inc. | Past | Accepting new patients | |
| Head Well PC | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Psychologist
- San Diego, CA
- NPI 1578885513
-
- Psychiatric/Mental Health Nurse Practitioner
- Eugene, OR
- NPI 1265129209
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1183075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1033316468",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4452 PARK BLVD",
"address_2": "SUITE 101",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921164051",
"telephone_number": "866-842-8927",
"fax_number": "866-842-8927"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4452 PARK BLVD",
"address_2": "SUITE 101",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921164051",
"telephone_number": "866-842-8927",
"fax_number": "866-842-8927"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENDRAGON",
"first_name": "DIANE",
"middle_name": "K.",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-06-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY20239",
"primary": true
}
],
"identifiers": [],
"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.