Individual provider Active NPI

Mia Velarde

  • Marriage & Family Therapist
  • Rancho Cucamonga, CA
National Provider Identifier
1528499266
Registry record updated Sep 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
105835 Issued in CA
Practice address
7020 Tolentino PL Apt Suite
Rancho Cucamonga, CA 91701-9003
Phone
(951) 374-0983
NPI assigned
Dec 5, 2013
Last updated
Sep 20, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X IMF74883 CA
Marriage & Family Therapist 106H00000X IMF74883 CA
Marriage & Family Therapist 106H00000X 105835 CA Primary

Addresses

Primary practice location

7020 Tolentino PL Apt Suite
Rancho Cucamonga, CA 91701-9003

Mailing address

2021 21St Ave S
Nashville, TN 37212-4342

Other practice location 1

2021 21st Ave S
Nashville, TN 37212-4342
Phone (909) 238-8474

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
I20241212001117 CA Practitioner - Marriage and Family Therapist 9638605793 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
105835CAMDMarriage & Family Therapist
IMF74883CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Thriveworks Clinical - California PC Mental Health CurrentSince Nov 27, 2024 Accepting new patients
Mia Velarde Marriage & Family Therapist CurrentSince Sep 23, 2024 Accepting new patients

Locations

171 Saxony Rd
Ste 106
Encinitas, CA 92024
Phone (760) 640-0270

116 S Catalina Ave
Ste 109
Redondo Beach, CA 90277
Phone (617) 454-4916

2525 Camino del Rio S
Ste 301
San Diego, CA 92108
Phone (209) 689-2669

1000 Jefferson St
Ste 2C
Lynchburg, VA 24504
Phone (434) 528-3263

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1386201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726790400000",
    "number": "1528499266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2021 21ST AVE S",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372124342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7020 TOLENTINO PL APT SUITE",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917019003",
            "telephone_number": "951-374-0983"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2021 21st Ave S",
            "address_purpose": "LOCATION",
            "city": "Nashville",
            "state": "TN",
            "postal_code": "372124342",
            "country_code": "US",
            "telephone_number": "909-238-8474",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VELARDE",
        "first_name": "MIA",
        "name_prefix": "Miss",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-12-05",
        "last_updated": "2024-09-20",
        "certification_date": "2024-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "IMF74883",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "IMF74883",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "105835",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rancho Cucamonga, CA

Sources for this page

Verify at the official NPI Registry.