Active NPI
Komaneche T Maxwell, SCHOOL PSYCHOLOGIST
- School Psychologist
- Rialto, CA
National Provider Identifier
1508161548
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- 343535
- Practice address
- 665 W Winchester Dr
Rialto, CA 92376-3237 - Phone
- (951) 809-3592
- NPI assigned
- Jan 24, 2011
- Last updated
- Oct 21, 2013
- 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 |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 343535 | NM | Primary |
Addresses
Primary practice location
665 W Winchester Dr
Rialto, CA 92376-3237
Mailing address
665 W Winchester Dr
Rialto, CA 92376-3237
Phone (951) 809-3592
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 343535 | NM | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1295827200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1382313600000",
"number": "1508161548",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "665 W WINCHESTER DR",
"city": "RIALTO",
"state": "CA",
"postal_code": "923763237",
"telephone_number": "951-809-3592"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "665 W WINCHESTER DR",
"city": "RIALTO",
"state": "CA",
"postal_code": "923763237",
"telephone_number": "951-809-3592"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAXWELL",
"first_name": "KOMANECHE",
"middle_name": "T",
"credential": "SCHOOL PSYCHOLOGIST",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-01-24",
"last_updated": "2013-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "NM",
"license": "343535",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rialto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.