Active NPI
Phylicia Nicole Medeiros, SCHOOL PSYCHOLOGY
- School Psychologist
- Manteca, CA
National Provider Identifier
1639961634
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- 230188558
- Practice address
- 1757 Flaxen CT # 59
Manteca, CA 95337-8152 - Phone
- (209) 535-2415
- NPI assigned
- May 19, 2025
- Last updated
- May 19, 2025
- Sex
- Unspecified or another gender identity
- 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 |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 230188558 | CA | Primary |
Addresses
Primary practice location
1757 Flaxen CT # 59
Manteca, CA 95337-8152
Mailing address
1757 Flaxen CT
Manteca, CA 95337-8152
Phone (209) 535-2415
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 230188558 | CA | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1747612800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1747612800000",
"number": "1639961634",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1757 FLAXEN CT",
"city": "MANTECA",
"state": "CA",
"postal_code": "953378152",
"telephone_number": "209-535-2415"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1757 FLAXEN CT # 59",
"city": "MANTECA",
"state": "CA",
"postal_code": "953378152",
"telephone_number": "209-535-2415"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDEIROS",
"first_name": "PHYLICIA",
"middle_name": "NICOLE",
"credential": "SCHOOL PSYCHOLOGY",
"sole_proprietor": "NO",
"sex": "X",
"enumeration_date": "2025-05-19",
"last_updated": "2025-05-19",
"certification_date": "2025-05-18",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "CA",
"license": "230188558",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manteca, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.