Individual provider Active NPI

Kenneth Michael Loya, PH.D.

  • Psychologist
  • San Luis Obispo, CA
National Provider Identifier
1083047377
Registry record updated Sep 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
35291 Issued in CA
Practice address
555 Chorro St Ste B
San Luis Obispo, CA 93405-2398
Phone
(805) 903-2074
NPI assigned
Aug 9, 2013
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 17, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X CA
Psychologist 103T00000X 35291 CA Primary

Addresses

Primary practice location

555 Chorro St Ste B
San Luis Obispo, CA 93405-2398

Mailing address

PO Box 1811
San Luis Obispo, CA 93406-1811
Phone (805) 903-2074

Other practice location 1

10333 El Camino Real
Atascadero, CA 93422-5808
Phone (805) 468-2000

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
I20240917000403 CA Practitioner - Clinical Psychologist 3779024864 Reassigns benefits to 1 organization
Practice locations: San Luis Obispo, CA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

555 Chorro St
Suite B
San Luis Obispo, CA 93405-2398
Phone (805) 903-2074

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35291CAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Department of State Hospitals Current Accepting new patients
Department of State Hospitals CurrentSince Aug 28, 2024 Accepting new patients

Locations

10333 El Camino Real
Atascadero, CA 93422
Phone (805) 468-2000

1215 O St
#3
Sacramento, CA 95814
Phone (916) 651-2805

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.

NPI Registry JSON

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

{
    "created_epoch": "1376006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726531200000",
    "number": "1083047377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1811",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934061811",
            "telephone_number": "805-903-2074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 CHORRO ST STE B",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934052398",
            "telephone_number": "805-903-2074"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10333 El Camino Real",
            "address_purpose": "LOCATION",
            "city": "Atascadero",
            "state": "CA",
            "postal_code": "934225808",
            "country_code": "US",
            "telephone_number": "805-468-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LOYA",
        "first_name": "KENNETH",
        "middle_name": "MICHAEL",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-08-09",
        "last_updated": "2024-09-17",
        "certification_date": "2024-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "35291",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Luis Obispo, CA

Sources for this page

Verify at the official NPI Registry.