Active NPI
David Gentry
- Clinical Psychologist
- San Diego, CA
National Provider Identifier
1184726150
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2-4381
- Practice address
- 4715 Viewridge Ave Ste 230
San Diego, CA 92123-1680 - Phone
- (800) 257-8715
- Fax
- (800) 819-1655
- NPI assigned
- Sep 1, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2-4381 | TX | Primary |
Addresses
Primary practice location
4715 Viewridge Ave Ste 230
San Diego, CA 92123-1680
Mailing address
3429 Wharton Dr
Fort Worth, TX 76133-2231
Phone (817) 346-7378
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 113238302 | Medicaid | TX | |
| 86068A | Other | TX | BCBS |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2-4381 | TX | MD | Clinical Psychologist |
| 24381 | TX | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157068800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1184726150",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3429 WHARTON DR",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761332231",
"telephone_number": "817-346-7378"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4715 VIEWRIDGE AVE STE 230",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921231680",
"telephone_number": "800-257-8715",
"fax_number": "800-819-1655"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GENTRY",
"first_name": "DAVID",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TX",
"license": "2-4381",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "113238302",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "86068A",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.