Jaclyn Nematbakhsh

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

93586 Issued in CA

Practice address

2423 Camino del Rio S Ste 101
San Diego, CA 92108-3734

Phone

(619) 880-6427

NPI assigned

May 9, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 2, 2024 through Jan 2, 2028

Medicare enrollment (NPD)

Not 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.

• Living Within Therapy- Marriage and Family Therapy

  • Marriage & Family Therapist
  • San Diego, CA
  • NPI 1629641311
  NPD Authorized official
• San Diego Center for Children

  • Community/Behavioral Health Agency
  • Escondido, CA
  • NPI 1669893301
  NPD (past)

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

{
    "created_epoch": "1304899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586908800000",
    "number": "1225320229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2423 CAMINO DEL RIO S STE 101",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921083734",
            "telephone_number": "619-880-6427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2423 CAMINO DEL RIO S STE 101",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921083734",
            "telephone_number": "619-880-6427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEMATBAKHSH",
        "first_name": "JACLYN",
        "name_prefix": "Miss",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-05-09",
        "last_updated": "2020-04-15",
        "certification_date": "2020-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "72479",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "93586",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tracy Beth Nelson, NP
• Trevin Nelson, RBT
• Yuliana Noniyeva Nelson, PHD
• Zoe Nelson
• Diana Nelte
• Adia A Nembhard, MFC53593
• Jackie Irene Nembo Kom, APRN, AGPCNP-BC,
• Allison Nemecek
• Rand Khouri Nemeh, MD
• Claudia Nemeth

• Marriage & Family Therapist in San Diego, CA
• Providers in San Diego, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.