Active NPI
Mona Devich-Navarro, PH.D.
- Clinical Psychologist
- Culver City, CA
National Provider Identifier
1649562034
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY#22881
- Practice address
- 12021 Wagner St.
Culver City, CA 90230 - Phone
- (310) 863-6979
- NPI assigned
- May 4, 2011
- Last updated
- May 4, 2011
- Sex
- Female
- 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 | PSY#22881 | CA | Primary |
Addresses
Primary practice location
12021 Wagner St.
Culver City, CA 90230
Mailing address
12021 Wagner St.
Culver City, CA 90230
Phone (310) 863-6979
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jun 1, 2024 through Jun 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY#22881 | CA | MD | Clinical Psychologist |
| 22881 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1304467200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1304467200000",
"number": "1649562034",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12021 WAGNER ST.",
"city": "CULVER CITY",
"state": "CA",
"postal_code": "90230",
"telephone_number": "310-863-6979"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12021 WAGNER ST.",
"city": "CULVER CITY",
"state": "CA",
"postal_code": "90230",
"telephone_number": "310-863-6979"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEVICH-NAVARRO",
"first_name": "MONA",
"name_prefix": "Ms.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-05-04",
"last_updated": "2011-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY#22881",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Culver City, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.