Individual provider Active NPI

Jill Noelle Virgen, MFTI

  • Marriage & Family Therapist
  • San Bernardino, CA
National Provider Identifier
1508260985
Registry record updated Oct 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
77336 Issued in CA
Practice address
396 W 25TH St
San Bernardino, CA 92405-3726
Phone
(909) 388-1239
NPI assigned
Oct 14, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 77336 CA Primary

Addresses

Primary practice location

396 W 25TH St
San Bernardino, CA 92405-3726

Mailing address

396 W 25TH St
San Bernardino, CA 92405-3726
Phone (909) 388-1239

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
I20240531001875 CA Practitioner - Marriage and Family Therapist 2163864414 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
102564CAMDPediatric Dentist
77336CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Center for New Directions, Inc. CurrentSince Mar 30, 2024 Accepting new patients
Stephen M Pumphrey Licensed Clinical Social Workers Inc PastSince Dec 25, 2018 Accepting new patients

Locations

23201 Mill Creek Dr
Ste 220
Laguna Hills, CA 92653
Phone (949) 460-5320

7177 Brockton Ave
Ste 111
Riverside, CA 92506
Phone (949) 460-5322

1100 Melody Ln
Ste 108
Roseville, CA 95678

41690 Enterprise Cir N
Ste 106
Temecula, CA 92590
Phone (951) 378-6080

Organizations & group practices 3

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": "1413244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413244800000",
    "number": "1508260985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "396 W 25TH ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924053726",
            "telephone_number": "909-388-1239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "396 W 25TH ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924053726",
            "telephone_number": "909-388-1239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIRGEN",
        "first_name": "JILL",
        "middle_name": "NOELLE",
        "credential": "MFTI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-14",
        "last_updated": "2014-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "77336",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Bernardino, CA

Sources for this page

Verify at the official NPI Registry.