Active NPI
Joseph Aguayo, PH.D
- Clinical Psychologist
- Los Angeles, CA
National Provider Identifier
1639799406
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY8389
- Practice address
- 11849 W Olympic Blvd Ste 202
Los Angeles, CA 90064-1148 - Phone
- (310) 478-7636
- NPI assigned
- Apr 22, 2020
- Sex
- Male
- 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 | PSY8389 | CA | Primary |
Addresses
Primary practice location
11849 W Olympic Blvd Ste 202
Los Angeles, CA 90064-1148
Mailing address
8420 Kirkwood Dr
Los Angeles, CA 90046-1928
Phone (323) 481-3745
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 |
|---|---|---|---|
| PSY8389 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1587513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1587513600000",
"number": "1639799406",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8420 KIRKWOOD DR",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900461928",
"telephone_number": "323-481-3745"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11849 W OLYMPIC BLVD STE 202",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900641148",
"telephone_number": "310-478-7636"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AGUAYO",
"first_name": "JOSEPH",
"name_prefix": "Dr.",
"credential": "PH.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-04-22",
"last_updated": "2020-04-22",
"certification_date": "2020-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY8389",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.