Gina Atencio-Maclean

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2855 Issued in CA

Practice address

647 Camino de Los Mares Ste 221
San Clemente, CA 92673-2807

Phone

(949) 228-9080

NPI assigned

Aug 1, 2011

Last updated

Feb 17, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 1, 2019 through Oct 1, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1312156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487289600000",
    "number": "1194003608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "629 CAMINO DE LOS MARES",
            "address_2": "STE 207A",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926732832",
            "telephone_number": "949-228-9080",
            "fax_number": "844-602-4623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "647 CAMINO DE LOS MARES STE 221",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926732807",
            "telephone_number": "949-228-9080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ATENCIO-MACLEAN",
        "first_name": "GINA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-01",
        "last_updated": "2017-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "2855",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in San Clemente, CA
• Providers in San Clemente, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.