Active NPI
Brenton Roman, PSY.D.
- Clinical Psychologist
- Chula Vista, CA
National Provider Identifier
1669947792
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY30333
- Practice address
- 865 3Rd Ave
Chula Vista, CA 91911-1300 - Phone
- (619) 409-1600
- NPI assigned
- Oct 4, 2018
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY30333 | CA | Primary |
Addresses
Primary practice location
865 3Rd Ave
Chula Vista, CA 91911-1300
Mailing address
6161 El Cajon Blvd Ste B509
San Diego, CA 92115-3922
Phone (203) 513-1208
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 |
|---|---|---|---|
| PSY30333 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1538611200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1538611200000",
"number": "1669947792",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6161 EL CAJON BLVD STE B509",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921153922",
"telephone_number": "203-513-1208"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "865 3RD AVE",
"city": "CHULA VISTA",
"state": "CA",
"postal_code": "919111300",
"telephone_number": "619-409-1600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROMAN",
"first_name": "BRENTON",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-10-04",
"last_updated": "2018-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY30333",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chula Vista, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.