Active NPI
Augustine Panchoo, PSYD
- Psychologist
- Redlands, CA
National Provider Identifier
1083861215
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSB 33585
- Practice address
- 101 E Redlands Blvd
#234
Redlands, CA 92373-4775 - Phone
- (909) 335-3026
- NPI assigned
- Aug 19, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSB 33585 | CA | Primary |
Addresses
Primary practice location
101 E Redlands Blvd
#234
Redlands, CA 92373-4775
Mailing address
615 E Lugonia Ave
#3
Redlands, CA 92374-2487
Phone (909) 798-2239
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSB 33585 | CA | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dignity Health Medical Foundation | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Multi-Specialty Clinic/Center
- Highland, CA
- NPI 1053653873
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219104000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1219104000000",
"number": "1083861215",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "615 E LUGONIA AVE",
"address_2": "#3",
"city": "REDLANDS",
"state": "CA",
"postal_code": "923742487",
"telephone_number": "909-798-2239"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 E REDLANDS BLVD",
"address_2": "#234",
"city": "REDLANDS",
"state": "CA",
"postal_code": "923734775",
"telephone_number": "909-335-3026"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PANCHOO",
"first_name": "AUGUSTINE",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-08-19",
"last_updated": "2008-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSB 33585",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Redlands, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.