Active NPI
Tanya Mesirow, PH.D
- Clinical Psychologist
- Temecula, CA
National Provider Identifier
1659336204
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY17044
- Practice address
- 28999 Old Town Front St
Suite 105
Temecula, CA 92590-5805 - Phone
- (951) 775-4057
- Fax
- (951) 302-9235
- NPI assigned
- Apr 18, 2006
- Last updated
- Sep 1, 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 | PSY17044 | CA | Primary |
Addresses
Primary practice location
28999 Old Town Front St
Suite 105
Temecula, CA 92590-5805
Mailing address
28999 Old Town Front St
Suite 105
Temecula, CA 92590-5805
Phone (951) 775-4057
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 1, 2024 through Jul 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY17044 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145318400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1314835200000",
"number": "1659336204",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "28999 OLD TOWN FRONT ST",
"address_2": "SUITE 105",
"city": "TEMECULA",
"state": "CA",
"postal_code": "925905805",
"telephone_number": "951-775-4057",
"fax_number": "951-302-9235"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "28999 OLD TOWN FRONT ST",
"address_2": "SUITE 105",
"city": "TEMECULA",
"state": "CA",
"postal_code": "925905805",
"telephone_number": "951-775-4057",
"fax_number": "951-302-9235"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MESIROW",
"first_name": "TANYA",
"credential": "PH.D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-04-18",
"last_updated": "2011-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY17044",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Temecula, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 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.