NPIMap

Organization Active NPI

Regeneration Psychiatry

  • Psychiatry Physician
  • Redondo Beach, CA
National Provider Identifier
1285200584
Registry record updated Apr 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
REGENERATION PSYCHIATRY
Practice address
2512 Artesia Blvd Ste 320
Redondo Beach, CA 90278-3282
Phone
(424) 277-2899
Fax
(424) 277-2899
NPI assigned
May 28, 2021
Last updated
Apr 23, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2025

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

Authorized official

Name
Jobert Ballesteros Poblete, MDNPI 1063944759
Title
Coo
Phone
(424) 277-2821

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X NU Primary

Addresses

Primary practice location

2512 Artesia Blvd Ste 320
Redondo Beach, CA 90278-3282

Mailing address

2512 Artesia Blvd Ste 320
Redondo Beach, CA 90278-3282
Phone (424) 277-2899

Other practice location 1

5757 Wilshire Blvd Ste 448
Los Angeles, CA 90036-3658
Phone (424) 277-2899

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211005000739 CA Part B Supplier - Clinic/Group Practice 3072911122 Receives reassigned benefits from 14 practitioners
Practice locations: Redondo Beach, CA; Los Angeles, CA

National Provider Directory

National Provider Directory

Locations

5757 Wilshire Blvd
Ste 448
Los Angeles, CA 90036
Phone (424) 277-2821

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/24050/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1622160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745366400000",
    "number": "1285200584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2512 ARTESIA BLVD STE 320",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902783282",
            "telephone_number": "424-277-2899",
            "fax_number": "424-277-2899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2512 ARTESIA BLVD STE 320",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902783282",
            "telephone_number": "424-277-2899",
            "fax_number": "424-277-2899"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5757 Wilshire Blvd Ste 448",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900363658",
            "country_code": "US",
            "telephone_number": "424-277-2899",
            "fax_number": "424-277-2899",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "REGENERATION PSYCHIATRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-28",
        "last_updated": "2025-04-23",
        "certification_date": "2025-04-23",
        "status": "A",
        "authorized_official_last_name": "POBLETE",
        "authorized_official_first_name": "JOBERT",
        "authorized_official_middle_name": "BALLESTEROS",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "424-277-2821",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Redondo Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.