Individual provider Active NPI

Mitra N/a Taheri

  • Marriage & Family Therapist
  • San Jose, CA
National Provider Identifier
1417199829
Registry record updated Dec 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
49018 Issued in CA
Practice address
1885 The Alameda Ste 100K
San Jose, CA 95126-1744
Phone
(408) 202-1309
NPI assigned
Mar 31, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 49018 CA Primary

Addresses

Primary practice location

1885 The Alameda Ste 100K
San Jose, CA 95126-1744

Mailing address

1885 The Alameda Ste 100K
San Jose, CA 95126-1744
Phone (408) 202-1309

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260116002054 CA Practitioner - Marriage and Family Therapist 4385121680 Practice locations: San Jose, CA

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1600 The Alameda
Suite 104
San Jose, CA 95126-2306

1600 The Alameda
Suite 104
San Jose, CA 95126-2341
Phone (408) 202-1309

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
49018CAMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1238457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545868800000",
    "number": "1417199829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1885 THE ALAMEDA STE 100K",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951261744",
            "telephone_number": "408-202-1309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1885 THE ALAMEDA STE 100K",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951261744",
            "telephone_number": "408-202-1309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAHERI",
        "first_name": "MITRA",
        "middle_name": "N/A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-03-31",
        "last_updated": "2018-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "49018",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.