Active NPI
Grace Elaine Barbara Peterson, PHD
- Psychologist
- San Diego, CA
National Provider Identifier
1518657154
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY34164
- Practice address
- 3350 La Jolla Village Dr # 116KM
San Diego, CA 92161-2251 - Phone
- (858) 833-5931
- NPI assigned
- May 8, 2023
- Sex
- Female
- Sole proprietor
- No
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 | PSY34164 | CA | Primary |
Addresses
Primary practice location
3350 La Jolla Village Dr # 116KM
San Diego, CA 92161-2251
Mailing address
8875 Aero Dr
San Diego, CA 92123-2251
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY34164 | CA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1683504000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683504000000",
"number": "1518657154",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8875 AERO DR",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921232251"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3350 LA JOLLA VILLAGE DR # 116KM",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921612251",
"telephone_number": "858-833-5931"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "GRACE",
"middle_name": "ELAINE BARBARA",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-05-08",
"last_updated": "2023-05-08",
"certification_date": "2023-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY34164",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.