Active NPI
Mark Miculian, PH.D.
- Clinical Psychologist
- Exeter, CA
National Provider Identifier
1639419658
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY14797
- Practice address
- 559 High Sierra Dr
Exeter, CA 93221-9509 - Phone
- (559) 594-5853
- Fax
- (559) 566-4295
- NPI assigned
- Feb 28, 2013
- 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 | PSY14797 | CA | Primary |
Addresses
Primary practice location
559 High Sierra Dr
Exeter, CA 93221-9509
Mailing address
559 High Sierra Drive
Exeter, CA 93221
Phone (559) 594-5853
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 |
|---|---|---|---|
| PSY14797 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1362009600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1362009600000",
"number": "1639419658",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "559 HIGH SIERRA DRIVE",
"city": "EXETER",
"state": "CA",
"postal_code": "93221",
"telephone_number": "559-594-5853",
"fax_number": "559-566-4295"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "559 HIGH SIERRA DR",
"city": "EXETER",
"state": "CA",
"postal_code": "932219509",
"telephone_number": "559-594-5853",
"fax_number": "559-566-4295"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MICULIAN",
"first_name": "MARK",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-02-28",
"last_updated": "2013-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY14797",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Exeter, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.