NPIMap

Organization Active NPI

San Marino Psychiatric Associates, Inc.

  • Psychiatry Physician
  • San Marino, CA
National Provider Identifier
1063540938
Registry record updated Aug 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
SAN MARINO PSYCHIATRIC ASSOCIATES, INC.
Practice address
2400 Mission St
San Marino, CA 91108
Phone
(626) 403-8999
Fax
(626) 403-8989
NPI assigned
Mar 1, 2007
Last updated
Aug 22, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2018

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

Authorized official

Name
Ms. Lupe A Quintanilla
Title
Office Manager
Phone
(626) 403-8999

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

2400 Mission St
San Marino, CA 91108

Mailing address

2400 Mission Street
San Marino, CA 91108-1632
Phone (626) 403-8999

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040713001664 CA Part B Supplier - Clinic/Group Practice 6709864895 Receives reassigned benefits from 7 practitioners
Practice locations: San Marino, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534896000000",
    "number": "1063540938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 MISSION STREET",
            "city": "SAN MARINO",
            "state": "CA",
            "postal_code": "911081632",
            "telephone_number": "626-403-8999",
            "fax_number": "626-403-8989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 MISSION ST",
            "city": "SAN MARINO",
            "state": "CA",
            "postal_code": "91108",
            "telephone_number": "626-403-8999",
            "fax_number": "626-403-8989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN MARINO PSYCHIATRIC ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2018-08-22",
        "status": "A",
        "authorized_official_last_name": "QUINTANILLA",
        "authorized_official_first_name": "LUPE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "626-403-8999",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Marino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.