Active NPI
Jonathon M Rose, PH.D.
- Adult Development & Aging Psychologist
- San Mateo, CA
National Provider Identifier
1154382380
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Development & Aging Psychologist
- License
- PSY12143
- Practice address
- 327 N San Mateo Dr
Suite 3
San Mateo, CA 94401-2543 - Phone
- (650) 703-4769
- NPI assigned
- Mar 29, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 7
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | PSY12143 | CA | |
| Adult Development & Aging Psychologist | 103TA0700X | PSY12143 | CA | Primary |
| Clinical Psychologist | 103TC0700X | PSY12143 | CA | |
| Forensic Psychologist | 103TF0200X | PSY12143 | CA | |
| Health Service Psychologist | 103TH0100X | PSY12143 | CA | |
| Psychologist | 103T00000X | PSY12143 | CA | |
| Rehabilitation Psychologist | 103TR0400X | PSY12143 | CA |
Addresses
Primary practice location
327 N San Mateo Dr
Suite 3
San Mateo, CA 94401-2543
Mailing address
411 Hillcrest Rd
San Carlos, CA 94070-1918
Phone (650) 703-4769
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PSY121430 | Medicaid | CA |
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY12143 | CA | MD | Health Service Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143590400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1280361600000",
"number": "1154382380",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "411 HILLCREST RD",
"city": "SAN CARLOS",
"state": "CA",
"postal_code": "940701918",
"telephone_number": "650-703-4769"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "327 N SAN MATEO DR",
"address_2": "SUITE 3",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944012543",
"telephone_number": "650-703-4769"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSE",
"first_name": "JONATHON",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-03-29",
"last_updated": "2010-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "CA",
"license": "PSY12143",
"primary": false
},
{
"code": "103TA0700X",
"taxonomy_group": "",
"desc": "Psychologist, Adult Development & Aging",
"state": "CA",
"license": "PSY12143",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY12143",
"primary": false
},
{
"code": "103TF0200X",
"taxonomy_group": "",
"desc": "Psychologist, Forensic",
"state": "CA",
"license": "PSY12143",
"primary": false
},
{
"code": "103TH0100X",
"taxonomy_group": "",
"desc": "Psychologist, Health Service",
"state": "CA",
"license": "PSY12143",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY12143",
"primary": false
},
{
"code": "103TR0400X",
"taxonomy_group": "",
"desc": "Psychologist, Rehabilitation",
"state": "CA",
"license": "PSY12143",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PSY121430",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Mateo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.