Active NPI
Jeffrey Joseph Rea, PSYD
- Clinical Psychologist
- Los Angeles, CA
National Provider Identifier
1396046660
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 23854
- Practice address
- 626 Wilshire Blvd
Ste 910
Los Angeles, CA 90017-3209 - Phone
- (213) 293-4925
- Fax
- (213) 622-5633
- NPI assigned
- Nov 3, 2010
- Sex
- Male
- 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 | 23854 | CA | Primary |
Addresses
Primary practice location
626 Wilshire Blvd
Ste 910
Los Angeles, CA 90017-3209
Mailing address
626 Wilshire Blvd
Ste 910
Los Angeles, CA 90017-3209
Phone (213) 293-4925
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 |
|---|---|---|---|
| 23854 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1288742400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1380585600000",
"number": "1396046660",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "626 WILSHIRE BLVD",
"address_2": "STE 910",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900173209",
"telephone_number": "213-293-4925",
"fax_number": "213-622-5633"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "626 WILSHIRE BLVD",
"address_2": "STE 910",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900173209",
"telephone_number": "213-293-4925",
"fax_number": "213-622-5633"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REA",
"first_name": "JEFFREY",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-11-03",
"last_updated": "2013-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "23854",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.