San Diego Psychological Center Inc.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

22844 Issued in CA

Legal business name

SAN DIEGO PSYCHOLOGICAL CENTER INC.

Practice address

15525 Pomerado Rd
Suite B3
Poway, CA 92064-2435

Phone

(760) 607-6463

Fax

(760) 607-3433

NPI assigned

Jan 21, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Banafsheh Pezeshk, PSY.DNPI 1184959009

Title

Ceo

Phone

(760) 607-6463

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• SDPC Other name

Electronic endpoints 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Banafsheh Pezeshk, PSY.D.

  • Clinical Psychologist
  • Poway, CA
  • NPI 1184959009
  NPD Authorized official
• Maximilian Masahito Kubota

  • Marriage & Family Therapist
  • Carlsbad, CA
  • NPI 1225478613
  NPD (past)
• Carolyn Quisenberry, PSY.D

  • Clinical Psychologist
  • Poway, CA
  • NPI 1255710893
  NPD (past)
• Jadelyn Thanh Wang, LMFT

  • Marriage & Family Therapist
  • Poway, CA
  • NPI 1043538770
  NPD (past)

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

{
    "created_epoch": "1421798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633737600000",
    "number": "1083003586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2258 SUNSET DR",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920256613",
            "telephone_number": "760-607-6463",
            "fax_number": "760-607-3433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15525 POMERADO RD",
            "address_2": "SUITE B3",
            "city": "POWAY",
            "state": "CA",
            "postal_code": "920642435",
            "telephone_number": "760-607-6463",
            "fax_number": "760-607-3433"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2258 Sunset Dr",
            "address_purpose": "LOCATION",
            "city": "Escondido",
            "state": "CA",
            "postal_code": "920256613",
            "country_code": "US",
            "telephone_number": "760-607-6463",
            "fax_number": "760-607-3433",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SAN DIEGO PSYCHOLOGICAL CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-21",
        "last_updated": "2021-10-09",
        "certification_date": "2021-10-09",
        "status": "A",
        "authorized_official_last_name": "PEZESHK",
        "authorized_official_first_name": "BANAFSHEH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "760-607-6463",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "CA",
            "license": "22844",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERSONAL NPI",
            "identifier": "1184959009",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "contact@sandiegopsychologicalcenter.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2258 Sunset Dr",
            "city": "Escondido",
            "state": "CA",
            "country_code": "US",
            "postal_code": "920256613",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "SDPC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "SDPC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Psychologist in Poway, CA
• Providers in Poway, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.