Alpha Theta Center, Inc

Primary specialty

PsychologistTaxonomy code 103T00000X

Legal business name

ALPHA THETA CENTER, INC

Practice address

6540 Lusk Blvd Ste C175
San Diego, CA 92121-2768

Phone

(858) 952-7660

NPI assigned

Nov 15, 2019

Organization subpart

No

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

Authorized official

Name

Michael Villanueva, PHD

Title

Ceo/Clinic Director

Phone

(858) 952-7660

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1573776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611705600000",
    "number": "1215572003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6540 LUSK BLVD STE C175",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921212768",
            "telephone_number": "858-952-7660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6540 LUSK BLVD STE C175",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921212768",
            "telephone_number": "858-952-7660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALPHA THETA CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-15",
        "last_updated": "2021-01-27",
        "certification_date": "2021-01-27",
        "status": "A",
        "authorized_official_last_name": "VILLANUEVA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO/CLINIC DIRECTOR",
        "authorized_official_telephone_number": "858-952-7660",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in San Diego, CA
• Providers in San Diego, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2021; 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.