Jessica L Taverniti, PSY.D, BCBA-D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY 26598 Issued in CA

Practice address

10855 Sorrento Valley Rd Ste 204
San Diego, CA 92121-1615

Phone

(619) 800-8145

NPI assigned

Sep 19, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Kula Wellness Psychological Corp

  • Psychologist
  • La Jolla, CA
  • NPI 1184348906
  NPD Authorized official

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

{
    "created_epoch": "1316390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661817600000",
    "number": "1134401805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6455 LA JOLLA BLVD UNIT 142",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920376633",
            "telephone_number": "406-570-6184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10855 SORRENTO VALLEY RD STE 204",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211615",
            "telephone_number": "619-800-8145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAVERNITI",
        "first_name": "JESSICA",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "PSY.D, BCBA-D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-19",
        "last_updated": "2022-08-30",
        "certification_date": "2022-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CA",
            "license": "1-11-8560",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY 26598",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PSYCHOLOGY BOARD",
            "identifier": "PSY-PSY-LIC-3580",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PSYCHOLOGY BOARD",
            "identifier": "PSY 26598",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BEHAVIOR ANALYST CERTIFICATION BOARD",
            "identifier": "1-11-8560",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Zoe Tauxe
• Melody Deborah Tavakoli, O.D.
• Adriana Maria Tavares Gomes, MD
• Rebecca Tavares
• Aimee Payumo Tavera, RN
• Jessica Brooke Tavison, LMT
• Victoria A Tavitian
• Madeleine Tawadros, DMD
• Rita Tawfeeq, RN
• Adel Rasmy Tawfilis, DDS

• Clinical Psychologist in San Diego, CA
• Providers in San Diego, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2022; 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.