Active NPI
Jose Antonio Cholula Bruno, MA, EDD
- Clinical Psychologist
- Santa Ana, CA
National Provider Identifier
1578873584
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY32179
- Practice address
- 525 Cabrillo Park Dr
Suite 300
Santa Ana, CA 92701-5017 - Phone
- (714) 953-4455
- Fax
- (714) 547-8856
- NPI assigned
- Oct 13, 2010
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY32179 | CA | Primary |
Addresses
Primary practice location
525 Cabrillo Park Dr
Suite 300
Santa Ana, CA 92701-5017
Mailing address
525 Cabrillo Park Dr
Suite 300
Santa Ana, CA 92701-5017
Phone (714) 953-4455
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
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY32179 | CA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cholula Psychological Services | Psychologist | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Santa Ana, CA
- NPI 1386230860
Psychologist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1286928000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623715200000",
"number": "1578873584",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "525 CABRILLO PARK DR",
"address_2": "SUITE 300",
"city": "SANTA ANA",
"state": "CA",
"postal_code": "927015017",
"telephone_number": "714-953-4455",
"fax_number": "714-547-8856"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "525 CABRILLO PARK DR",
"address_2": "SUITE 300",
"city": "SANTA ANA",
"state": "CA",
"postal_code": "927015017",
"telephone_number": "714-953-4455",
"fax_number": "714-547-8856"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHOLULA BRUNO",
"first_name": "JOSE",
"middle_name": "ANTONIO",
"credential": "MA, EDD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-10-13",
"last_updated": "2021-06-15",
"certification_date": "2021-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY32179",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Ana, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.