Maria Avila Gengenbacher, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY 21014 Issued in CA

Practice address

4929 Wilshire Blvd Ste 510
Los Angeles, CA 90010-3820

Phone

(888) 307-0893

Fax

(310) 734-5511

NPI assigned

Aug 17, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Maria Avila Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1250467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554854400000",
    "number": "1508098021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4929 WILSHIRE BLVD STE 510",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900103820",
            "telephone_number": "888-307-0893",
            "fax_number": "310-734-5511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4929 WILSHIRE BLVD STE 510",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900103820",
            "telephone_number": "888-307-0893",
            "fax_number": "310-734-5511"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5122 Katella Ave.",
            "address_2": "Suite 307",
            "address_purpose": "LOCATION",
            "city": "Los Alamitos",
            "state": "CA",
            "postal_code": "90720",
            "country_code": "US",
            "telephone_number": "424-201-1600",
            "fax_number": "424-201-1601",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GENGENBACHER",
        "first_name": "MARIA",
        "middle_name": "AVILA",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-17",
        "last_updated": "2019-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY 21014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARIA",
            "last_name": "AVILA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Clinical Psychologist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.