NPIMap

Organization Active NPI

Image Transformation Institute

  • Clinical Psychologist
  • Del Mar, CA
National Provider Identifier
1376572438
Registry record updated Jun 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
IMAGE TRANSFORMATION INSTITUTE
Practice address
1343 Stratford CT
Del Mar, CA 92014-2327
Phone
(626) 429-4945
Fax
(858) 724-3585
NPI assigned
Jul 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2019

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

Authorized official

Name
Dr. Robert Michael Miller, PH.D.NPI 1316036759
Title
President
Phone
(626) 429-4945

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
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X Primary

Addresses

Primary practice location

1343 Stratford CT
Del Mar, CA 92014-2327

Mailing address

1111 Klish Way
Del Mar, CA 92014-2633
Phone (626) 676-5942

Other identifiers 1

IdentifierTypeStateIssuer
WCP20630AOtherCAPPIN FOR ROBERT MILLER CP

Other names 1

  • PsychTech Former legal business name

National Provider Directory

National Provider Directory

Locations

2900 E Del Mar Blvd
Pasadena, CA 91107
Phone (310) 559-5916

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1151712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561593600000",
    "number": "1376572438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 KLISH WAY",
            "city": "DEL MAR",
            "state": "CA",
            "postal_code": "920142633",
            "telephone_number": "626-676-5942",
            "fax_number": "858-724-3585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1343 STRATFORD CT",
            "city": "DEL MAR",
            "state": "CA",
            "postal_code": "920142327",
            "telephone_number": "626-429-4945",
            "fax_number": "858-724-3585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMAGE TRANSFORMATION INSTITUTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-01",
        "last_updated": "2019-06-27",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "626-429-4945",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PPIN FOR ROBERT MILLER CP",
            "identifier": "WCP20630A",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PsychTech",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Del Mar, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.