Individual provider Active NPI

Rudy Frederick Deasis, LMFT

  • Marriage & Family Therapist
  • Commerce, CA
National Provider Identifier
1255597928
Registry record updated Feb 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
52021 Issued in CA
Practice address
5400 E Olympic Blvd FL 1
Commerce, CA 90022-5147
Phone
(323) 869-9255
NPI assigned
Aug 1, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 52021 CA Primary

Addresses

Primary practice location

5400 E Olympic Blvd FL 1
Commerce, CA 90022-5147

Mailing address

815 Colorado Blvd Ste 300
Los Angeles, CA 90041-1744
Phone (323) 543-2800

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260210003884 CA Practitioner - Marriage and Family Therapist 1254810120 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2008
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

2008 N Garey Ave
Pomona, CA 91767-2722

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
52021CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Tri-City Mental Health Authority CurrentSince Dec 27, 2025 Accepting new patients
Tri-City Mental Health Center PastSince Dec 27, 2025 Accepting new patients

Locations

2008 N Garey Ave
Pomona, CA 91767
Phone (909) 242-7640

Organizations & group practices 2

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": "1217548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614211200000",
    "number": "1255597928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 COLORADO BLVD STE 300",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900411744",
            "telephone_number": "323-543-2800",
            "fax_number": "323-978-1263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5400 E OLYMPIC BLVD FL 1",
            "city": "COMMERCE",
            "state": "CA",
            "postal_code": "900225147",
            "telephone_number": "323-869-9255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEASIS",
        "first_name": "RUDY",
        "middle_name": "FREDERICK",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-01",
        "last_updated": "2021-02-25",
        "certification_date": "2021-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "52021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Commerce, CA

Sources for this page

Verify at the official NPI Registry.