Banafsheh Pezeshk, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

22843 Issued in CA

Practice address

15525 Pomerado Rd
Suite B3
Poway, CA 92064-2435

Phone

(760) 607-6463

Fax

(760) 607-3433

NPI assigned

Oct 9, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• I Don'T DO Addictive Drugs

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Poway, CA
  • NPI 1376065433
  NPD Authorized official
• San Diego Psychological Center Inc.

  • Psychologist
  • Poway, CA
  • NPI 1083003586

  Clinical

  NPD Authorized official

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

{
    "created_epoch": "1255046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484006400000",
    "number": "1184959009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15525 POMERADO RD",
            "address_2": "SUITE B3",
            "city": "POWAY",
            "state": "CA",
            "postal_code": "920642435",
            "telephone_number": "760-607-6463",
            "fax_number": "760-607-3433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15525 POMERADO RD",
            "address_2": "SUITE B3",
            "city": "POWAY",
            "state": "CA",
            "postal_code": "920642435",
            "telephone_number": "760-607-6463",
            "fax_number": "760-607-3433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEZESHK",
        "first_name": "BANAFSHEH",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-10-09",
        "last_updated": "2017-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "22843",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelsey Michelle Perez
• Julie Perkins, AAHCC
• Jocelyn Perpuly
• Peter a. Rich, D.M.D. Inc.
• Jennifer Lynne Peters, RN
• Gem T Pham, DDS
• Hanh My Pham, DDS
• Kevin Pham
• Philip Wrotslavsky, DPM, a Professional Corporation
• Julien Philippe

• Clinical Psychologist in Poway, CA
• Providers in Poway, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.