Active NPI
Regina Petterson, PSY.D.
- Psychologist
- Los Angeles, CA
National Provider Identifier
1417059965
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY18490
- Practice address
- 11980 San Vicente Blvd
Suite 701
Los Angeles, CA 90049-5012 - Phone
- (310) 462-3134
- NPI assigned
- Sep 5, 2006
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY18490 | CA | Primary |
Addresses
Primary practice location
11980 San Vicente Blvd
Suite 701
Los Angeles, CA 90049-5012
Mailing address
11980 San Vicente Blvd
Suite 701
Los Angeles, CA 90049-5012
Phone (310) 462-3134
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 284973 | Other | CA | MHN |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Teladoc Health Medical Group, P.a. | Psychologist | Current | Accepting new patients |
Interoperability endpoints
- reginapetterson@tdh.allscriptsdirect.net
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 and National Provider Directory roles.
-
- Family Medicine Physician
- Lewisville, TX
- NPI 1245403567
Psychologist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157414400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1417059965",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11980 SAN VICENTE BLVD",
"address_2": "SUITE 701",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900495012",
"telephone_number": "310-462-3134"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11980 SAN VICENTE BLVD",
"address_2": "SUITE 701",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900495012",
"telephone_number": "310-462-3134"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTERSON",
"first_name": "REGINA",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY18490",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MHN",
"identifier": "284973",
"state": "CA"
}
],
"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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.