Active NPI
Rafael Gavidia
- Mental Health Counselor
- Cerritos, CA
National Provider Identifier
1649400979
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- ASW73379
- Practice address
- 10929 South St
Suite #208B
Cerritos, CA 90703-5340 - Phone
- (562) 924-5526
- Fax
- (562) 924-1040
- NPI assigned
- Jul 21, 2009
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Practitioner | 225400000X | |||
| Mental Health Counselor | 101YM0800X | ASW73379 | CA | Primary |
Addresses
Primary practice location
10929 South St
Suite #208B
Cerritos, CA 90703-5340
Mailing address
10929 South St
Suite #208B
Cerritos, CA 90703-5340
Phone (562) 924-5526
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 |
|---|---|---|---|
| ASW73379 | CA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1248134400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1474416000000",
"number": "1649400979",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10929 SOUTH ST",
"address_2": "SUITE #208B",
"city": "CERRITOS",
"state": "CA",
"postal_code": "907035340",
"telephone_number": "562-924-5526",
"fax_number": "562-924-1040"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10929 SOUTH ST",
"address_2": "SUITE #208B",
"city": "CERRITOS",
"state": "CA",
"postal_code": "907035340",
"telephone_number": "562-924-5526",
"fax_number": "562-924-1040"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAVIDIA",
"first_name": "RAFAEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-07-21",
"last_updated": "2016-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "ASW73379",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cerritos, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.