NPIMap

Organization Active NPI

Pacifica Neuropsychology Center, Inc

  • Mental Health Counselor
  • San Pedro, CA
National Provider Identifier
1558808667
Registry record updated Jan 26, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
PACIFICA NEUROPSYCHOLOGY CENTER, INC
Practice address
461 W 6TH St Ste 211
San Pedro, CA 90731-2677
Phone
(310) 547-0084
NPI assigned
Jan 26, 2017
Last updated
Jan 26, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2017

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

Authorized official

Name
Marida Mares
Title
Clinical Director
Phone
(310) 547-0084

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

461 W 6TH St Ste 211
San Pedro, CA 90731-2677

Mailing address

461 W 6TH St Ste 211
San Pedro, CA 90731-2677

National Provider Directory

National Provider Directory
Tax ID family
Pacifica Neuropsychology Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

461 W 6th St
Ste 211
San Pedro, CA 90731
Phone (310) 547-0084

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": "1485388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485388800000",
    "number": "1558808667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "461 W 6TH ST STE 211",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907312677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "461 W 6TH ST STE 211",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907312677",
            "telephone_number": "310-547-0084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFICA NEUROPSYCHOLOGY CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-26",
        "last_updated": "2017-01-26",
        "status": "A",
        "authorized_official_last_name": "MARES",
        "authorized_official_first_name": "MARIDA",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "310-547-0084"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Pedro, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2017; 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.