Active NPI
Idalia E. McGivern, PH.D.
- Clinical Psychologist
- La Mesa, CA
National Provider Identifier
1609820398
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY18250
- Practice address
- 9340 Fuerte Dr
Suite 300
La Mesa, CA 91941-4164 - Phone
- (619) 303-0826
- Fax
- (619) 315-0454
- NPI assigned
- May 19, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 | PSY18250 | CA | Primary |
Addresses
Primary practice location
9340 Fuerte Dr
Suite 300
La Mesa, CA 91941-4164
Mailing address
9340 Fuerte Dr
Suite 300
La Mesa, CA 91941-4164
Phone (619) 303-0826
Other names 1
- Dr. Idalia E. Canez
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140115000902 | CA | Practitioner - Clinical Psychologist | 3779734199 | Practice locations: La Mesa, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
8697 La Mesa Blvd
La Mesa, CA 91942-9565
9323 Dillon Dr
La Mesa, CA 91941-4234
Phone (619) 303-0826
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY18250 | CA | MD | Clinical Psychologist |
| 18250 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147996800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1375142400000",
"number": "1609820398",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9340 FUERTE DR",
"address_2": "SUITE 300",
"city": "LA MESA",
"state": "CA",
"postal_code": "919414164",
"telephone_number": "619-303-0826",
"fax_number": "619-315-0454"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9340 FUERTE DR",
"address_2": "SUITE 300",
"city": "LA MESA",
"state": "CA",
"postal_code": "919414164",
"telephone_number": "619-303-0826",
"fax_number": "619-315-0454"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCGIVERN",
"first_name": "IDALIA",
"middle_name": "E.",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-05-19",
"last_updated": "2013-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY18250",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "IDALIA",
"last_name": "CANEZ",
"middle_name": "E.",
"prefix": "DR.",
"credential": "PH.D.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in La Mesa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.