Individual provider Active NPI

Johanna Rengifo Nevarez, PH.D.

  • Clinical Neuropsychologist
  • San Francisco, CA
National Provider Identifier
1033628144
Registry record updated Sep 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
Practice address
1001 Potrero Ave
San Francisco, CA 94110-3518
Phone
(415) 206-3305
NPI assigned
Sep 21, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X Primary

Addresses

Primary practice location

1001 Potrero Ave
San Francisco, CA 94110-3518

Mailing address

1862 Camino Verde Apt O
Walnut Creek, CA 94597-2203
Phone (510) 512-5333

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190620001486 CA Practitioner - Clinical Psychologist 0042544371 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Regents of the University of CaliforniaGroup PAC ID 8022922475, 562 clinicians
Sutter Bay Medical FoundationGroup PAC ID 4284538778, 3,783 clinicians

Practice addresses (Care Compare)

100 N Wiget LN
Suite 150
Walnut Creek, CA 94598-5900
Phone (925) 357-6515

1100 Van Ness Ave
San Francisco, CA 94109-6978
Phone (415) 600-0140

3838 California St
San Francisco, CA 94118-1506

4860 Y St
Sacramento, CA 95817-2307

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
30916CAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of California CurrentSince Jan 1, 2023 Accepting new patients
Regents of the Univ of Ca CurrentSince Apr 8, 2021 Accepting new patients
Regents of the Univ of Ca Current Accepting new patients
Sutter Bay Medical Foundation Current Accepting new patients
Sutter Bay Medical Foundation CurrentSince Dec 19, 2022 Accepting new patients
Sutter Bay Medical Foundation CurrentSince Dec 19, 2022 Accepting new patients
Regents of the Univ of Ca CurrentSince Apr 8, 2021 Accepting new patients
Sutter East Bay Medical Foundation Past Accepting new patients
Sutter Bay Hospitals Past Accepting new patients
Essent PRMC LP Past Accepting new patients
Regents of the Univ of Ca Past Accepting new patients
Sutter East Bay Medical Foundation Past Accepting new patients

Locations

18400 US Highway 18
Apple Valley, CA 92307
Phone (760) 810-7590

350 John Muir Pkwy
Ste 160
Brentwood, CA 94513
Phone (925) 204-1920

1950 University Ave
Ste 160
East Palo Alto, CA 94303
Phone (650) 317-8100

3200 Kearney St
Fremont, CA 94538
Phone (510) 498-2800

1189 E Herndon Ave
Ste 103
Fresno, CA 93720
Phone (559) 450-7777

370 Distel Cir
Los Altos, CA 94022
Phone (650) 254-5200

600 Coffee Rd
Modesto, CA 95355
Phone (209) 550-4755

101 Rowland Way
Ste 220
Novato, CA 94945
Phone (415) 878-7200

795 El Camino Real
Palo Alto, CA 94301
Phone (650) 324-1832

1555 East St
Ste 200
Redding, CA 96001
Phone (530) 229-0911

151 N Sunrise Ave
Ste 1205
Roseville, CA 95661
Phone (916) 789-1505

4860 Y St
Ste 100
Sacramento, CA 95817
Phone (916) 734-3588

4860 Y St
Ste 200
Sacramento, CA 95817
Phone (916) 734-3761

4860 Y St
Sacramento, CA 95817
Phone (916) 734-2700

4900 Broadway
Ste 1200
Sacramento, CA 95820
Phone (916) 734-9255

3838 California St
Rm 410
San Francisco, CA 94118
Phone (415) 751-1847

45 Castro St
Ste 220
San Francisco, CA 94114
Phone (415) 600-5555

45 Castro St
San Francisco, CA 94114
Phone (415) 241-5695

601 Duboce Ave
Ste 165
San Francisco, CA 94117

123 S San Mateo Dr
San Mateo, CA 94401
Phone (650) 343-4200

3883 Airway Dr
Ste 220
Santa Rosa, CA 95403
Phone (707) 521-7750

10200 Trinity Pkwy
Ste 101
Stockton, CA 95219
Phone (209) 323-3488

100 N Wiget Ln
Ste 150
Walnut Creek, CA 94598
Phone (855) 420-2612

Organizations & group practices 12

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1505952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1505952000000",
    "number": "1033628144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1862 CAMINO VERDE APT O",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945972203",
            "telephone_number": "510-512-5333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 POTRERO AVE",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941103518",
            "telephone_number": "415-206-3305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RENGIFO NEVAREZ",
        "first_name": "JOHANNA",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-21",
        "last_updated": "2017-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Francisco, CA

Sources for this page

Verify at the official NPI Registry.