Active NPI
Rene Mary Keres, PSYD
- Clinical Psychologist
- San Bernardino, CA
National Provider Identifier
1386783777
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY22708
- Practice address
- 303 E Vanderbilt Way
San Bernardino, CA 92415-0026 - Phone
- (909) 386-8259
- NPI assigned
- Feb 5, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY22708 | CA | Primary |
Addresses
Primary practice location
303 E Vanderbilt Way
San Bernardino, CA 92415-0026
Mailing address
303 E Vanderbilt Way
San Bernardino, CA 92415-0026
Phone (909) 388-5600
Other practice location 1
2940 Inland Empire Blvd
Ontario, CA 91764-4898
Phone (909) 458-1350
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY22708 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170633600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623974400000",
"number": "1386783777",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "303 E VANDERBILT WAY",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924150026",
"telephone_number": "909-388-5600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "303 E VANDERBILT WAY",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924150026",
"telephone_number": "909-386-8259"
}
],
"practiceLocations": [
{
"address_1": "2940 Inland Empire Blvd",
"address_purpose": "LOCATION",
"city": "Ontario",
"state": "CA",
"postal_code": "917644898",
"country_code": "US",
"telephone_number": "909-458-1350",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KERES",
"first_name": "RENE",
"middle_name": "MARY",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-05",
"last_updated": "2021-06-18",
"certification_date": "2021-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY22708",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Bernardino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.