Individual provider Active NPI

Raphael Ziegler, PH.D.

  • Clinical Neuropsychologist
  • Redondo Beach, CA
National Provider Identifier
1497895601
Registry record updated Sep 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
PSY21258 Issued in CA
Practice address
1014 S Pacific Coast Hwy
Suite 102
Redondo Beach, CA 90277-4765
Phone
(310) 855-3288
Fax
(310) 855-3498
NPI assigned
Feb 7, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2018

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X PSY21258 CA Primary
Psychologist 103T00000X PSY21258 CA
Adult Development & Aging Psychologist 103TA0700X PSY21258 CA
Cognitive & Behavioral Psychologist 103TB0200X PSY21258 CA
Clinical Psychologist 103TC0700X PSY21258 CA

Addresses

Primary practice location

1014 S Pacific Coast Hwy
Suite 102
Redondo Beach, CA 90277-4765

Mailing address

326 S Pacific Coast Hwy
Ste 200
Redondo Beach, CA 90277-3769
Phone (310) 855-3288

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
I20071016000351 CA Practitioner - Clinical Psychologist 0547356925 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2004
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

326 S Pacific Coast Hwy
Suite 200
Redondo Beach, CA 90277-3769
Phone (310) 855-3288

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
Q Psychology Group, a Psychological Corporation Clinical CurrentSince Jan 1, 2023 Accepting new patients
William R. Shankle MD Inc. CurrentSince Nov 1, 2019 Accepting new patients
Psychological Wellness Clinical Past Accepting new patients
Natalie Thome, Licensed Clinical Social Worker, Inc. PastSince Oct 29, 2023 Accepting new patients
BNL Health Inc. Past Accepting new patients

Locations

3900 W Coast Hwy
Ste 310
Newport Beach, CA 92663
Phone (949) 478-8858

225 Avenue I
Ste 204
Redondo Beach, CA 90277
Phone (310) 855-3288

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536278400000",
    "number": "1497895601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "326 S PACIFIC COAST HWY",
            "address_2": "STE 200",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902773769",
            "telephone_number": "310-855-3288",
            "fax_number": "310-855-3498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1014 S PACIFIC COAST HWY",
            "address_2": "SUITE 102",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902774765",
            "telephone_number": "310-855-3288",
            "fax_number": "310-855-3498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZIEGLER",
        "first_name": "RAPHAEL",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-07",
        "last_updated": "2018-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "CA",
            "license": "PSY21258",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY21258",
            "primary": false
        },
        {
            "code": "103TA0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Adult Development & Aging",
            "state": "CA",
            "license": "PSY21258",
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "CA",
            "license": "PSY21258",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY21258",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Redondo Beach, CA

Sources for this page

Verify at the official NPI Registry.