NPIMap

Organization Active NPI

San Pedro Healing Arts Medical Clinic Inc

  • Professional Counselor
  • Lake Forest, CA
National Provider Identifier
1538549563
Registry record updated Jun 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
PCCI 1592 Issued in CA
Legal business name
SAN PEDRO HEALING ARTS MEDICAL CLINIC INC
Practice address
22706 Aspan St
Suite 702
Lake Forest, CA 92630-1603
Phone
(949) 427-1013
NPI assigned
Jun 4, 2015
Last updated
Jun 4, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2015

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

Authorized official

Name
Stephanie Fiamengo, LMFTNPI 1437467958
Title
Executive Director
Phone
(310) 547-2197

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X PCCI 1592 CA Primary

Addresses

Primary practice location

22706 Aspan St
Suite 702
Lake Forest, CA 92630-1603

Mailing address

1366 W 7TH St
Suite 4B
San Pedro, CA 90732-3500
Phone (310) 547-2197

National Provider Directory

National Provider Directory
Tax ID family
Naoki Kamoshida DC Lac7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

22706 Aspan St
Ste 702
Lake Forest, CA 92630
Phone (949) 385-3093

1366 W 7th St
Ste 4B
San Pedro, CA 90732
Phone (310) 547-2197

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1433376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433376000000",
    "number": "1538549563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1366 W 7TH ST",
            "address_2": "SUITE 4B",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907323500",
            "telephone_number": "310-547-2197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22706 ASPAN ST",
            "address_2": "SUITE 702",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926301603",
            "telephone_number": "949-427-1013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN PEDRO HEALING ARTS MEDICAL CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-04",
        "last_updated": "2015-06-04",
        "status": "A",
        "authorized_official_last_name": "FIAMENGO",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "310-547-2197",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CA",
            "license": "PCCI 1592",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Forest, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.