Active NPI
Max Defrain
- Marriage & Family Therapist
- Oceanside, CA
National Provider Identifier
1477074268
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 109978
- Practice address
- 3605 Vista Way Ste 258
Oceanside, CA 92056-4565 - Phone
- (760) 758-1480
- NPI assigned
- Jun 30, 2017
- 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 |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 109978 | CA | Primary |
Addresses
Primary practice location
3605 Vista Way Ste 258
Oceanside, CA 92056-4565
Mailing address
3605 Vista Way Ste 258
Oceanside, CA 92056-4565
Phone (760) 758-1480
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Nov 13, 2024 through Nov 13, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 109978 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1498780800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1477074268",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3605 VISTA WAY STE 258",
"city": "OCEANSIDE",
"state": "CA",
"postal_code": "920564565",
"telephone_number": "760-758-1480"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3605 VISTA WAY STE 258",
"city": "OCEANSIDE",
"state": "CA",
"postal_code": "920564565",
"telephone_number": "760-758-1480"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEFRAIN",
"first_name": "MAX",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-06-30",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "109978",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oceanside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.