Active NPI
Joaquin Lopez de San Roman
- Marriage & Family Therapist
- Sebastopol, CA
National Provider Identifier
1215482773
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 45971
- Practice address
- 2650 Burnside Rd
Sebastopol, CA 95472-9424 - Phone
- (707) 328-1793
- Fax
- (707) 664-4104
- NPI assigned
- Aug 24, 2016
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 45971 | CA | Primary |
Addresses
Primary practice location
2650 Burnside Rd
Sebastopol, CA 95472-9424
Mailing address
2650 Burnside Rd
Sebastopol, CA 95472-9424
Phone (707) 328-1793
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 45971 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1471996800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1471996800000",
"number": "1215482773",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2650 BURNSIDE RD",
"city": "SEBASTOPOL",
"state": "CA",
"postal_code": "954729424",
"telephone_number": "707-328-1793",
"fax_number": "707-664-4104"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2650 BURNSIDE RD",
"city": "SEBASTOPOL",
"state": "CA",
"postal_code": "954729424",
"telephone_number": "707-328-1793",
"fax_number": "707-664-4104"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOPEZ DE SAN ROMAN",
"first_name": "JOAQUIN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-08-24",
"last_updated": "2016-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "45971",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sebastopol, CA
- Emily Linders, LMFT
- Michael Jon Lipelt, DDS, ND, L.AC.
- Lips Chiropractic Inc (Featherstone Family Chiropractic and Wellness)
- Live Oak Rest Home
- Longs Drug Stores California LLC (CVS Pharmacy #09872)
- Maya Lopez, LCSW
- James Arthur Lowy, MD
- Xochiquetzal Carmela Lubin-Amaya, LMFT
- Luis T Luna Meza
- Susan Thomas Macdonald, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 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.