NPIMap

Individual provider Active NPI

Sandra Bahena-Colley, PH.D.

  • Clinical Psychologist
  • San Diego, CA
National Provider Identifier
1073742268
Registry record updated Feb 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY29792 Issued in CA
Practice address
4060 Fairmount Ave
San Diego, CA 92105-1608
Phone
(619) 564-8765
Fax
(619) 564-8786
NPI assigned
Jul 8, 2009
Last updated
Feb 14, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X
Psychologist 103T00000X PSY29792 CA
Clinical Psychologist 103TC0700X PSY29792 CA Primary

Addresses

Primary practice location

4060 Fairmount Ave
San Diego, CA 92105-1608

Mailing address

4060 Fairmount Ave
San Diego, CA 92105-1608
Phone (619) 564-8765

Other names 1

  • Dr. Sandra Bahena Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220215002610 CA Practitioner - Clinical Psychologist 5294128260 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PSY29792CAMDClinical Psychologist
29792CAMDNeonatal/Pediatric Registered Respiratory Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
La Maestra Family Clinic, Inc. Current Accepting new patients
La Maestra Family Clinic, Inc. CurrentSince Nov 3, 2021 Accepting new patients
La Maestra Family Clinic, Inc. CurrentSince Nov 3, 2021 Accepting new patients
La Maestra Family Clinic, Inc. PastSince May 8, 2022 Accepting new patients
La Maestra Family Clinic, Inc. PastSince May 1, 2022 Accepting new patients
La Maestra Family Clinic, Inc. PastSince May 8, 2022 Accepting new patients
La Maestra Family Clinic, Inc. PastSince May 8, 2022 Accepting new patients
La Maestra Family Clinic, Inc. PastSince May 8, 2022 Accepting new patients
La Maestra Family Clinic, Inc. PastSince Jun 5, 2022 Accepting new patients

Locations

165 S 1st St
El Cajon, CA 92019
Phone (619) 312-0347

217 Highland Ave
National City, CA 91950
Phone (619) 280-4213

4060 Fairmount Ave
San Diego, CA 92105
Phone (619) 255-9155

4157 Fairmount Ave
San Diego, CA 92105
Phone (619) 249-8255

4185 Fairmount Ave
San Diego, CA 92105
Phone (619) 280-1105

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: sandra.bahenacolley.p1@direct.lamaestra.nextgenshare.com

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1247011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644796800000",
    "number": "1073742268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4060 FAIRMOUNT AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921051608",
            "telephone_number": "619-564-8765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4060 FAIRMOUNT AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921051608",
            "telephone_number": "619-564-8765",
            "fax_number": "619-564-8786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAHENA-COLLEY",
        "first_name": "SANDRA",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-08",
        "last_updated": "2022-02-14",
        "certification_date": "2022-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY29792",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY29792",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SANDRA",
            "last_name": "BAHENA",
            "prefix": "DR.",
            "credential": "PH.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.