Active NPI
Purna Chandra Datta, PH.D.
- Clinical Psychologist
- Stockton, CA
National Provider Identifier
1275646036
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY10808
- Practice address
- 7510 Shoreline Dr
Suite a-6
Stockton, CA 95219-5495 - Phone
- (209) 406-6817
- Fax
- (209) 477-2935
- NPI assigned
- Aug 16, 2006
- Last updated
- Apr 12, 2012
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY10808 | CA | Primary |
Addresses
Primary practice location
7510 Shoreline Dr
Suite a-6
Stockton, CA 95219-5495
Mailing address
7510 Shoreline Dr
Suite a-6
Stockton, CA 95219-5495
Phone (209) 406-6817
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PSY10808 | Other | CA | BOARD OF PSYCHOLOGY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY10808 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1334188800000",
"number": "1275646036",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7510 SHORELINE DR",
"address_2": "SUITE A-6",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952195495",
"telephone_number": "209-406-6817",
"fax_number": "209-477-2935"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7510 SHORELINE DR",
"address_2": "SUITE A-6",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952195495",
"telephone_number": "209-406-6817",
"fax_number": "209-477-2935"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DATTA",
"first_name": "PURNA",
"middle_name": "CHANDRA",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-16",
"last_updated": "2012-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY10808",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BOARD OF PSYCHOLOGY",
"identifier": "PSY10808",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Stockton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.