Active NPI
Ingrid Sandberg, PHD
- Psychologist
- Dublin, CA
National Provider Identifier
1487751590
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY17111
- Practice address
- 11740 Dublin Blvd
Suite 202
Dublin, CA 94568-2823 - Phone
- (925) 479-0508
- Fax
- (925) 479-0587
- NPI assigned
- Sep 20, 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 | PSY17111 | CA | Primary |
Addresses
Primary practice location
11740 Dublin Blvd
Suite 202
Dublin, CA 94568-2823
Mailing address
11740 Dublin Blvd
Suite 202
Dublin, CA 94568-2823
Phone (925) 479-0508
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Feb 18, 2013 through Feb 18, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY17111 | CA | MD | Psychologist |
| 17111 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1416355200000",
"number": "1487751590",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11740 DUBLIN BLVD",
"address_2": "SUITE 202",
"city": "DUBLIN",
"state": "CA",
"postal_code": "945682823",
"telephone_number": "925-479-0508",
"fax_number": "925-479-0587"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11740 DUBLIN BLVD",
"address_2": "SUITE 202",
"city": "DUBLIN",
"state": "CA",
"postal_code": "945682823",
"telephone_number": "925-479-0508",
"fax_number": "925-479-0587"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANDBERG",
"first_name": "INGRID",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-20",
"last_updated": "2014-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY17111",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dublin, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2014; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.