Active NPI
Gina Fjelstad
- Marriage & Family Therapist
- Ontario, CA
National Provider Identifier
1255101614
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 134853
- Practice address
- 2545 S Euclid Ave
Ontario, CA 91762-6620 - Phone
- (714) 287-3262
- NPI assigned
- Jan 8, 2024
- Sex
- Female
- 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 | 134853 | CA | Primary |
Addresses
Primary practice location
2545 S Euclid Ave
Ontario, CA 91762-6620
Mailing address
2545 S Euclid Ave
Ontario, CA 91762-6620
Phone (714) 287-3262
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Marriage and Family Therapist
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
15235 Burbank Blvd
Suite A2
Sherman Oaks, CA 91411-3555
Phone (310) 306-0335
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pacific Blue Psychological Services | Multi-Specialty | Current | Accepting new patients |
Locations
3570 E Imperial Hwy
Lynwood, CA 90262
Phone (858) 883-3277
15235 Burbank Blvd
Ste A2
Van Nuys, CA 91411
Phone (949) 504-1963
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1704672000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704672000000",
"number": "1255101614",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2545 S EUCLID AVE",
"city": "ONTARIO",
"state": "CA",
"postal_code": "917626620",
"telephone_number": "714-287-3262"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2545 S EUCLID AVE",
"city": "ONTARIO",
"state": "CA",
"postal_code": "917626620",
"telephone_number": "714-287-3262"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FJELSTAD",
"first_name": "GINA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-01-08",
"last_updated": "2024-01-08",
"certification_date": "2024-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "134853",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ontario, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2024; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.