Active NPI
Kimberly Macias
- Mental Health Counselor
- Riverside, CA
National Provider Identifier
1104461003
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 2085 Rustin Ave
Riverside, CA 92507-2498 - Phone
- (951) 955-7108
- NPI assigned
- Nov 14, 2019
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary | ||
| Clinical Social Worker | 1041C0700X |
Addresses
Primary practice location
2085 Rustin Ave
Riverside, CA 92507-2498
Mailing address
2085 Rustin Ave
Riverside, CA 92507-2498
Other practice location 1
9645 Arrow Rte Ste A
Rancho Cucamonga, CA 91730-4554
Phone (909) 948-5747
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1573689600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1592265600000",
"number": "1104461003",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2085 RUSTIN AVE",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925072498"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2085 RUSTIN AVE",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925072498",
"telephone_number": "951-955-7108"
}
],
"practiceLocations": [
{
"address_1": "9645 Arrow Rte Ste A",
"address_purpose": "LOCATION",
"city": "Rancho Cucamonga",
"state": "CA",
"postal_code": "917304554",
"country_code": "US",
"telephone_number": "909-948-5747",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MACIAS",
"first_name": "KIMBERLY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-11-14",
"last_updated": "2020-06-16",
"certification_date": "2020-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.