Individual provider Active NPI

Alexandra Methratta, PSY

  • Clinical Psychologist
  • San Diego, CA
National Provider Identifier
1154154870
Registry record updated Sep 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
36553 Issued in CA
Practice address
5060 Shoreham PL Ste 330
San Diego, CA 92122-5976
Phone
(877) 840-6956
Fax
(619) 383-6701
NPI assigned
Aug 20, 2024
Last updated
Sep 9, 2026By the provider in NPPES
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 9, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 36553 CA Primary
Clinical Psychologist 103TC0700X PSY.0006297 CO

Addresses

Primary practice location

5060 Shoreham PL Ste 330
San Diego, CA 92122-5976

Mailing address

18336 Soledad Canyon Rd
PO Box 1361
Santa Clarita, CA 91386-3035
Phone (805) 334-0413

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, CA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20260317004640 CO Practitioner - Clinical Psychologist 0648754705 Reassigns benefits to 1 organization
I20260325003237 CA Practitioner - Clinical Psychologist 0648754705 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ehab Yacoub MD IncGroup PAC ID 5092099523, 179 clinicians

Practice addresses (Care Compare)

1225 W 190TH St
Suite 280
Gardena, CA 90248-4305
Phone (877) 515-8113

200 Union Blvd
Lakewood, CO 80228-1830
Phone (310) 515-8113

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PSY.0006297COMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Ehab Yacoub MD Inc. CurrentSince Mar 11, 2026 Accepting new patients

Locations

1225 W 190th St
Ste 280
Gardena, CA 90248
Phone (310) 515-8113

14541 Delano St
Van Nuys, CA 91411
Phone (310) 515-8113

1400 16th St
Denver, CO 80202
Phone (303) 748-5781

200 Union Blvd
Lakewood, CO 80228
Phone (303) 304-1352

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1724112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788912000000",
    "number": "1154154870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18336 SOLEDAD CANYON RD",
            "address_2": "PO BOX 1361",
            "city": "SANTA CLARITA",
            "state": "CA",
            "postal_code": "913863035",
            "telephone_number": "805-334-0413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5060 SHOREHAM PL STE 330",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921225976",
            "telephone_number": "877-840-6956",
            "fax_number": "619-383-6701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "METHRATTA",
        "first_name": "ALEXANDRA",
        "name_prefix": "Dr.",
        "credential": "PSY",
        "sole_proprietor": "YES",
        "sex": "U",
        "enumeration_date": "2024-08-20",
        "last_updated": "2026-09-09",
        "certification_date": "2026-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "36553",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CO",
            "license": "PSY.0006297",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.