Active NPI
Lola Vildavskaia, PHD
- Clinical Psychologist
- San Diego, CA
National Provider Identifier
1437267622
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY18986
- Practice address
- 4715 Viewridge Ave Ste 230
San Diego, CA 92123-1680 - Phone
- (800) 257-8715
- Fax
- (800) 819-1655
- NPI assigned
- Aug 28, 2006
- Sex
- Female
- Sole proprietor
- No
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 | PSY18986 | CA | Primary |
Addresses
Primary practice location
4715 Viewridge Ave Ste 230
San Diego, CA 92123-1680
Mailing address
36 Garden Grove Dr
Daly City, CA 94015-3049
Phone (650) 994-9008
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PSY018986 | Medicaid | CA |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050208001079 | CA | Practitioner - Clinical Psychologist | 5294786109 | Practice locations: San Francisco, CA; San Mateo, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1995
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
2299 Post St
Suite 104B
San Francisco, CA 94115-3443
Phone (415) 407-3638
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY18986 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156723200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1437267622",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "36 GARDEN GROVE DR",
"city": "DALY CITY",
"state": "CA",
"postal_code": "940153049",
"telephone_number": "650-994-9008"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4715 VIEWRIDGE AVE STE 230",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921231680",
"telephone_number": "800-257-8715",
"fax_number": "800-819-1655"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VILDAVSKAIA",
"first_name": "LOLA",
"name_prefix": "Ms.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY18986",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PSY018986",
"state": "CA"
}
],
"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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.