Individual provider Active NPI

Angela Marie Famous

  • Marriage & Family Therapist
  • San Diego, CA
National Provider Identifier
1396040390
Registry record updated Mar 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
99943 Issued in CA
Practice address
1401 Broadway
San Diego, CA 92101-5710
Phone
(619) 276-8112
Fax
(619) 276-8230
NPI assigned
Jan 21, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 70303 CA
Marriage & Family Therapist 106H00000X 99943 CA Primary

Addresses

Primary practice location

1401 Broadway
San Diego, CA 92101-5710

Mailing address

PO Box 421141
San Diego, CA 92142-1141
Phone (619) 276-8112

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
70303CAMDClinical Social Worker
99943CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Community Research Foundation Inc PastSince Mar 24, 2024 Accepting new patients
Pathways Community Services LLC Past Accepting new patients

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1295568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711152000000",
    "number": "1396040390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 421141",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921421141",
            "telephone_number": "619-276-8112",
            "fax_number": "619-276-8230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 BROADWAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921015710",
            "telephone_number": "619-276-8112",
            "fax_number": "619-276-8230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAMOUS",
        "first_name": "ANGELA",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-21",
        "last_updated": "2024-03-23",
        "certification_date": "2024-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "70303",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "99943",
            "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 Mar 23, 2024; 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.