Individual provider Active NPI

Carmina Lopez

  • Marriage & Family Therapist
  • San Diego, CA
National Provider Identifier
1639564396
Registry record updated Mar 31, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
IMF85747 Issued in CA
Practice address
873 Grissom St
San Diego, CA 92154-2343
Phone
(619) 240-0250
NPI assigned
Mar 31, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 31, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X IMF85747 CA Primary

Addresses

Primary practice location

873 Grissom St
San Diego, CA 92154-2343

Mailing address

873 Grissom St
San Diego, CA 92154-2343
Phone (619) 240-0250

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240304003235 CA Practitioner - Marriage and Family Therapist 5597100263 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

591 Camino de la Reina
Suite 802
San Diego, CA 92108-3110
Phone (858) 519-8002

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
115636CAMDSocial Worker
IMF85747CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Vanessa Villasenor Licensed Marriage and Family Therapist Inc CurrentSince Jan 2, 2024 Accepting new patients

Locations

591 Camino de la Reina
Ste 802
San Diego, CA 92108
Phone (858) 208-0815

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1427760000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427760000000",
    "number": "1639564396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "873 GRISSOM ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921542343",
            "telephone_number": "619-240-0250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "873 GRISSOM ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921542343",
            "telephone_number": "619-240-0250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOPEZ",
        "first_name": "CARMINA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-03-31",
        "last_updated": "2015-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "IMF85747",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.