Active NPI
Deanna Tavakoly
- Marriage & Family Therapist
- Santa Monica, CA
National Provider Identifier
1326697004
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 128223
- Practice address
- 2716 Ocean Park Blvd Ste 3075
Santa Monica, CA 90405-5232 - Phone
- (310) 612-2998
- NPI assigned
- Sep 5, 2019
- Sex
- Female
- Sole proprietor
- No
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 | 128223 | CA | Primary |
Addresses
Primary practice location
2716 Ocean Park Blvd Ste 3075
Santa Monica, CA 90405-5232
Mailing address
2716 Ocean Park Blvd Ste 3075
Santa Monica, CA 90405-5232
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective May 2, 2025 through May 2, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1567641600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722816000000",
"number": "1326697004",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2716 OCEAN PARK BLVD STE 3075",
"city": "SANTA MONICA",
"state": "CA",
"postal_code": "904055232"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2716 OCEAN PARK BLVD STE 3075",
"city": "SANTA MONICA",
"state": "CA",
"postal_code": "904055232",
"telephone_number": "310-612-2998"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAVAKOLY",
"first_name": "DEANNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-09-05",
"last_updated": "2024-08-05",
"certification_date": "2024-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "128223",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Monica, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.