Darrell L. Broaddus, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY 20101 Issued in CA

Practice address

8029 La Mesa Blvd
Suite a
La Mesa, CA 91941-6434

Phone

(619) 668-0600

Fax

(619) 466-2662

NPI assigned

Dec 18, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• Wellqor Psychological Services of California, PC

  • Clinical Psychologist
  • Murrieta, CA
  • NPI 1093173742
  NPD (past)

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

{
    "created_epoch": "1197936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1197936000000",
    "number": "1265616973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6461 ASPEN GARDENS WAY",
            "city": "CITRUS HEIGHTS",
            "state": "CA",
            "postal_code": "956215626",
            "telephone_number": "916-705-7388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8029 LA MESA BLVD",
            "address_2": "SUITE A",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919416434",
            "telephone_number": "619-668-0600",
            "fax_number": "619-466-2662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADDUS",
        "first_name": "DARRELL",
        "middle_name": "L.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-12-18",
        "last_updated": "2007-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY 20101",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cesar Brijandez, IMF
• Felicia R Briones-Colman, M.D.
• Julio Brionez, PHD
• Camille Brisbo, SLP
• Kent Harold Brizendine, M.P.T.
• Erin Broderick, RRT
• Tatiana Brodsky
• April Brohamer
• Andrew J Brown, MD
• Carlotta D Brown

• Clinical Psychologist in La Mesa, CA
• Providers in La Mesa, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2007; 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.