Active NPI
Regina Fagout
- Marriage & Family Therapist
- San Diego, CA
National Provider Identifier
1083097968
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 112511
- Practice address
- 2667 Camino del Rio S Ste 301-1
San Diego, CA 92108-3707 - Phone
- (858) 761-4246
- NPI assigned
- Jul 9, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 76447 | CA | |
| Marriage & Family Therapist | 106H00000X | 112511 | CA | Primary |
Addresses
Primary practice location
2667 Camino del Rio S Ste 301-1
San Diego, CA 92108-3707
Mailing address
PO Box 420295
San Diego, CA 92142-0295
Phone (858) 761-4246
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250110003360 | CA | Practitioner - Marriage and Family Therapist | 6901334473 | Practice locations: Poway, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 76447 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1436400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1677542400000",
"number": "1083097968",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 420295",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921420295",
"telephone_number": "858-761-4246"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2667 CAMINO DEL RIO S STE 301-1",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921083707",
"telephone_number": "858-761-4246"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAGOUT",
"first_name": "REGINA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-07-09",
"last_updated": "2023-02-28",
"certification_date": "2023-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "76447",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "112511",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.