Active NPI
Georgette Gavin, PH.D.
- Psychologist
- Oceanside, CA
National Provider Identifier
1508878331
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY 17330
- Practice address
- 2344 Fire Mountain Dr
Oceanside, CA 92054-6117 - Phone
- (760) 420-1500
- Fax
- (760) 721-3637
- NPI assigned
- Aug 12, 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 | PSY 17330 | CA | Primary |
Addresses
Primary practice location
2344 Fire Mountain Dr
Oceanside, CA 92054-6117
Mailing address
2344 Fire Mountain Dr
Oceanside, CA 92054-6117
Phone (760) 721-3637
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100222000609 | CA | Practitioner - Psychologist Billing Independently | 8527102003 |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1997
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
2344 Fire Mountain Dr
Oceanside, CA 92054-6117
Phone (760) 420-1500
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 17330 | CA | MD | Psychologist |
| 17330 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155340800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1677542400000",
"number": "1508878331",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2344 FIRE MOUNTAIN DR",
"city": "OCEANSIDE",
"state": "CA",
"postal_code": "920546117",
"telephone_number": "760-721-3637",
"fax_number": "760-721-3764"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2344 FIRE MOUNTAIN DR",
"city": "OCEANSIDE",
"state": "CA",
"postal_code": "920546117",
"telephone_number": "760-420-1500",
"fax_number": "760-721-3637"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAVIN",
"first_name": "GEORGETTE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-12",
"last_updated": "2023-02-28",
"certification_date": "2023-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY 17330",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oceanside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.