Active NPI
Paul McColes Whitaker, PHD
- Psychologist
- San Diego, CA
National Provider Identifier
1356339964
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY14205
- Practice address
- 4420 Hotel Circle CT
Suite 235
San Diego, CA 92108-3411 - Phone
- (619) 204-2382
- NPI assigned
- Oct 7, 2005
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY14205 | CA | Primary |
Addresses
Primary practice location
4420 Hotel Circle CT
Suite 235
San Diego, CA 92108-3411
Mailing address
3529 32ND St
San Diego, CA 92104-4302
Phone (619) 204-2382
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040803001686 | CA | Practitioner - Clinical Psychologist | 9335110345 | Practice locations: San Diego, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY14205 | CA | MD | Psychologist |
| 14205 | CA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128643200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1356339964",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3529 32ND ST",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921044302",
"telephone_number": "619-204-2382",
"fax_number": "619-692-0299"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4420 HOTEL CIRCLE CT",
"address_2": "SUITE 235",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921083411",
"telephone_number": "619-204-2382"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITAKER",
"first_name": "PAUL",
"middle_name": "MCCOLES",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY14205",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.