Active NPI
Irene Mayorgadiaz, PSYCHIATRIC TECH
- Licensed Psychiatric Technician
- Rosemead, CA
National Provider Identifier
1124623327
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Psychiatric Technician
- License
- 41284
- Practice address
- 2656 Muscatel Ave
Rosemead, CA 91770 - Phone
- (760) 373-0634
- NPI assigned
- Dec 3, 2020
- 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 |
|---|---|---|---|---|
| Licensed Psychiatric Technician | 167G00000X | 41284 | CA | Primary |
| Technician/Technologist | 156F00000X | PT41284 | CA |
Addresses
Primary practice location
2656 Muscatel Ave
Rosemead, CA 91770
Mailing address
510 S Vermont Ave
Los Angeles, CA 90020-1912
Phone (213) 407-4196
Other practice location 1
1774 Zonal Ave Bldg B
Los Angeles, CA 90033-1064
Phone (310) 221-6336
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PT41284 | Other | CA | PSYCHIATRIC TECHNICIAN |
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | n/a | Other | |
| CONNECT URL | n/a | Health Information Exchange (HIE) |
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 |
|---|---|---|---|
| PT41284 | CA | MD | Technician/Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1606953600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721692800000",
"number": "1124623327",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "510 S VERMONT AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900201912",
"telephone_number": "213-407-4196"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2656 MUSCATEL AVE",
"city": "ROSEMEAD",
"state": "CA",
"postal_code": "91770",
"telephone_number": "760-373-0634"
}
],
"practiceLocations": [
{
"address_1": "1774 Zonal Ave Bldg B",
"address_purpose": "LOCATION",
"city": "Los Angeles",
"state": "CA",
"postal_code": "900331064",
"country_code": "US",
"telephone_number": "310-221-6336",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MAYORGADIAZ",
"first_name": "IRENE",
"credential": "PSYCHIATRIC TECH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-12-03",
"last_updated": "2024-07-23",
"certification_date": "2024-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "167G00000X",
"taxonomy_group": "",
"desc": "Licensed Psychiatric Technician",
"state": "CA",
"license": "41284",
"primary": true
},
{
"code": "156F00000X",
"taxonomy_group": "",
"desc": "Technician/Technologist",
"state": "CA",
"license": "PT41284",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PSYCHIATRIC TECHNICIAN",
"identifier": "PT41284",
"state": "CA"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "n/a",
"affiliation": "N",
"endpointDescription": "n/a",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "n/a",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "n/a",
"address_1": "2656 Muscatel Ave",
"city": "Rosemead",
"state": "CA",
"country_code": "US",
"postal_code": "917703321",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "n/a",
"affiliation": "N",
"endpointDescription": "n/a",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "2656 Muscatel Ave",
"city": "Rosemead",
"state": "CA",
"country_code": "US",
"postal_code": "917703321",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Rosemead, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.