Individual provider Active NPI

Fatimah Safari

  • Psychiatric/Mental Health Nurse Practitioner
  • Fontana, CA
National Provider Identifier
1386425288
Registry record updated Jan 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
95027533 Issued in CA
Practice address
9176 Sierra Ave Ste 201B
Fontana, CA 92335-4709
Phone
(909) 223-5214
NPI assigned
Oct 9, 2023
Last updated
Jan 11, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 11, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 95027533 CA Primary
Psychiatric/Mental Health Registered Nurse 163WP0808X 95147132 CA

Addresses

Primary practice location

9176 Sierra Ave Ste 201B
Fontana, CA 92335-4709

Mailing address

9176 Sierra Ave Ste 201B
Fontana, CA 92335-4709
Phone (909) 223-5214

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: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240517003375 CA Practitioner - Nurse Practitioner 7416398649 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Interim Psychiatric Care Medical CorporationGroup PAC ID 8224068747, 3 clinicians

Practice addresses (Care Compare)

9327 Fairway View PL
Suite 110
Rancho Cucamonga, CA 91730-0969
Phone (909) 945-3330

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
95147132CAMDPsychiatric/Mental Health Registered Nurse
95027533CAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Interim Psychiatric Care, Medical Corporation CurrentSince Mar 29, 2024 Accepting new patients

Locations

9327 Fairway View Pl
Ste 110
Rch Cucamonga, CA 91730
Phone (909) 945-3330

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1696809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704931200000",
    "number": "1386425288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9176 SIERRA AVE STE 201B",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923354709",
            "telephone_number": "909-223-5214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9176 SIERRA AVE STE 201B",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923354709",
            "telephone_number": "909-223-5214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAFARI",
        "first_name": "FATIMAH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-10-09",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95027533",
            "primary": true
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95147132",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fontana, CA

Sources for this page

Verify at the official NPI Registry.