NPIMap

Organization Active NPI

CDCR

  • Psychologist
  • Ione, CA
National Provider Identifier
1134558240
Registry record updated Nov 8, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PSY18841 Issued in CA
Legal business name
CDCR
Practice address
4001 Highway 104
Ione, CA 95640
Phone
(209) 274-4911
Fax
(209) 274-5147
NPI assigned
Nov 8, 2013
Last updated
Nov 8, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2013

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

Authorized official

Name
Ko Bruce Fang, PH.D.NPI 1376664458
Title
Psychologist
Phone
(209) 274-4911

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X PSY18841 CA Primary

Addresses

Primary practice location

4001 Highway 104
Ione, CA 95640

Mailing address

5215 Lotus Pond Way
Elk Grove, CA 95757-4342
Phone (916) 296-5089

National Provider Directory

National Provider Directory
Tax ID family
Az Trans456 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1383868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383868800000",
    "number": "1134558240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5215 LOTUS POND WAY",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957574342",
            "telephone_number": "916-296-5089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4001 HIGHWAY 104",
            "city": "IONE",
            "state": "CA",
            "postal_code": "95640",
            "telephone_number": "209-274-4911",
            "fax_number": "209-274-5147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CDCR",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-08",
        "last_updated": "2013-11-08",
        "status": "A",
        "authorized_official_last_name": "FANG",
        "authorized_official_first_name": "KO",
        "authorized_official_middle_name": "BRUCE",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "209-274-4911",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY18841",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ione, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2013; 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.