Benjamin Zequeira-Russell

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY19727 Issued in CA

Practice address

140 E Colorado Blvd Ste D
Monrovia, CA 91016-5145

Phone

(626) 358-1564

NPI assigned

Apr 27, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Positive Development of California PC

  • Psychologist
  • Whittier, CA
  • NPI 1538769617
  NPD (past)
• Real Connections Child Development Institute

  • Community/Behavioral Health Agency
  • Monrovia, CA
  • NPI 1407114986
  NPD (past)

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

{
    "created_epoch": "1461715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461715200000",
    "number": "1215382254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 E COLORADO BLVD STE D",
            "city": "MONROVIA",
            "state": "CA",
            "postal_code": "910165145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 E COLORADO BLVD STE D",
            "city": "MONROVIA",
            "state": "CA",
            "postal_code": "910165145",
            "telephone_number": "626-358-1564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZEQUEIRA-RUSSELL",
        "first_name": "BENJAMIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-27",
        "last_updated": "2016-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY19727",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TYPE 2 NPI- REAL CONNECTIONS CHILD DEVELOPMENT INSTITUTE",
            "identifier": "1407114986",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexa Zepeda
• Jadalynn Zepeda
• Mario Zepeda
• Melissa Zepeda
• Vanessa Zepeda
• Huiqian Zhang
• Nicholas Zhang
• Thomas Zhong
• Jinyao Zhou
• Christopher Zhu

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.