Skywater Health

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

SKYWATER HEALTH

Practice address

26516 Crenshaw Blvd
Palos Verdes Peninsula, CA 90274-3970

Phone

(310) 541-7911

Fax

(310) 541-4256

NPI assigned

Mar 28, 2019

Last updated

Mar 28, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lorena Baroni

Title

Office Manager

Phone

(310) 541-7911

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1553731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553731200000",
    "number": "1124589478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26516 CRENSHAW BLVD",
            "city": "PALOS VERDES PENINSULA",
            "state": "CA",
            "postal_code": "902743970",
            "telephone_number": "310-541-7911",
            "fax_number": "310-541-4256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26516 CRENSHAW BLVD",
            "city": "PALOS VERDES PENINSULA",
            "state": "CA",
            "postal_code": "902743970",
            "telephone_number": "310-541-7911",
            "fax_number": "310-541-4256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKYWATER HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-28",
        "last_updated": "2019-03-28",
        "status": "A",
        "authorized_official_last_name": "BARONI",
        "authorized_official_first_name": "LORENA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "310-541-7911"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "1992734701",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1992734701",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Margaret Ann Hendricks, PH.D.
• Michelle Jay Kim, NP
• Raina Moosa, PSY.D.
• Loree Pham, PHD, OTR/L
• Jillian Schuchert Smith, PNP-PC
• Therapy Wherever You Are, a Psychological Corporation
• Westfield Health
• Marian J Wymore, M.D.
• Nancy Chiyeko Yoshiyama, PHARMD

• Primary Care Clinic/Center in Palos Verdes Peninsula, CA
• Providers in Palos Verdes Peninsula, CA by specialty
• Primary Care Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2019; 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.