Active NPI
Clint J Soares, PHD
- Forensic Psychologist
- Coalinga, CA
National Provider Identifier
1588694236
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Forensic Psychologist
- License
- PSY18782
- Practice address
- 24511 W Jayne Ave
Coalinga, CA 93210-9503 - Phone
- (559) 935-4301
- Fax
- (559) 935-7118
- NPI assigned
- Jul 4, 2006
- 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 |
|---|---|---|---|---|
| Forensic Psychologist | 103TF0200X | PSY18782 | CA | Primary |
Addresses
Primary practice location
24511 W Jayne Ave
Coalinga, CA 93210-9503
Mailing address
24511 W Jayne Ave
Coalinga, CA 93210-9503
Phone (559) 935-4301
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 |
|---|---|---|---|
| PSY18782 | CA | MD | Forensic Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151971200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1588694236",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24511 W JAYNE AVE",
"city": "COALINGA",
"state": "CA",
"postal_code": "932109503",
"telephone_number": "559-935-4301",
"fax_number": "559-935-7118"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24511 W JAYNE AVE",
"city": "COALINGA",
"state": "CA",
"postal_code": "932109503",
"telephone_number": "559-935-4301",
"fax_number": "559-935-7118"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOARES",
"first_name": "CLINT",
"middle_name": "J",
"name_prefix": "Mr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TF0200X",
"taxonomy_group": "",
"desc": "Psychologist, Forensic",
"state": "CA",
"license": "PSY18782",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coalinga, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.