Individual provider Active NPI

Hengameh Motaghed, PHD CLINICAL PSYCHOL

  • Psychologist
  • San Diego, CA
National Provider Identifier
1366550592
Registry record updated Aug 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PSY12707 Issued in CA
Practice address
591 Camino de la Reina
918
San Diego, CA 92108
Phone
(619) 969-6790
Fax
(619) 294-8190
NPI assigned
Aug 28, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 5, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PSY12707 CA Primary

Addresses

Primary practice location

591 Camino de la Reina
918
San Diego, CA 92108

Mailing address

3488 Voyager Circle
San Diego, CA 92130
Phone (619) 969-6790

Other identifiers 1

IdentifierTypeStateIssuer
2810724MedicaidCA

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
I20100830000521 CA Practitioner - Clinical Psychologist 1850415753 Practice locations: San Diego, CA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

14034 Boquita Dr
Del Mar, CA 92014-2945

591 Camino de la Reina
Suite 918
San Diego, CA 92108-3111
Phone (858) 922-4959

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
12707CAMDAcupuncturist

NPI Registry JSON

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

{
    "created_epoch": "1156723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280966400000",
    "number": "1366550592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3488 VOYAGER CIRCLE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92130",
            "telephone_number": "619-969-6790",
            "fax_number": "619-294-8190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "591 CAMINO DE LA REINA",
            "address_2": "918",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92108",
            "telephone_number": "619-969-6790",
            "fax_number": "619-294-8190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOTAGHED",
        "first_name": "HENGAMEH",
        "credential": "PHD CLINICAL PSYCHOL",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-28",
        "last_updated": "2010-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY12707",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2810724",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.