Individual provider Active NPI

Ruth L Millican

  • Psychologist
  • San Diego, CA
National Provider Identifier
1346472305
Registry record updated Dec 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PSY25354 Issued in CA
Practice address
1963 4TH Ave
San Diego, CA 92101-2394
Phone
(619) 233-3432
Fax
(619) 233-7022
NPI assigned
Aug 10, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PSY25354 CA Primary
Mental Health Counselor 101YM0800X

Addresses

Primary practice location

1963 4TH Ave
San Diego, CA 92101-2394

Mailing address

1963 4TH Ave
San Diego, CA 92101-2394
Phone (619) 233-3432

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
I20130816000576 CA Practitioner - Clinical Psychologist 0648412866 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Family Health Centers of San Diego Inc CurrentSince Sep 19, 2023 Accepting new patients
Family Health Centers of San Diego, Inc CurrentSince Sep 19, 2023 Accepting new patients
Family Health Centers of San Diego, Inc Current Accepting new patients
Community Research Foundation Inc Past Accepting new patients
Community Research Foundation Inc Past Accepting new patients

Locations

823 Gateway Center Way
San Diego, CA 92102
Phone (619) 515-2323

3544 30th St
San Diego, CA 92104
Phone (619) 515-2424

Organizations & group practices 5

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": "1249862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734912000000",
    "number": "1346472305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1963 4TH AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921012394",
            "telephone_number": "619-233-3432",
            "fax_number": "619-233-7022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1963 4TH AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921012394",
            "telephone_number": "619-233-3432",
            "fax_number": "619-233-7022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLICAN",
        "first_name": "RUTH",
        "middle_name": "L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-10",
        "last_updated": "2024-12-23",
        "certification_date": "2024-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY25354",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.