Active NPI
Gordon Luca Renwick, PSY.D
- Clinical Psychologist
- El Cajon, CA
National Provider Identifier
1679581953
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY 16183
- Practice address
- 900 N Cuyamaca St
Suite 206
El Cajon, CA 92020-1865 - Phone
- (619) 218-9181
- NPI assigned
- Aug 3, 2006
- Sex
- Male
- 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 16183 | CA | Primary |
Addresses
Primary practice location
900 N Cuyamaca St
Suite 206
El Cajon, CA 92020-1865
Mailing address
4825 Utah St
San Diego, CA 92116-1426
Phone (619) 284-6985
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PSY16183 | Medicaid | CA |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 16183 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154563200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1679581953",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4825 UTAH ST",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921161426",
"telephone_number": "619-284-6985"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "900 N CUYAMACA ST",
"address_2": "SUITE 206",
"city": "EL CAJON",
"state": "CA",
"postal_code": "920201865",
"telephone_number": "619-218-9181"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RENWICK",
"first_name": "GORDON",
"middle_name": "LUCA",
"name_prefix": "Dr.",
"credential": "PSY.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-03",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY 16183",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PSY16183",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in El Cajon, CA
- Reliancemed, Inc.
- Karla Anne Rella, CPNP
- Mariam Remus-Marante, MA
- Brooke P Renning
- Alvin Rentoria
- William Frank Resh, MD
- Angelica Grethel Retano
- Retina Institute of California Medical Group, a California Medical Par
- Retina Institute of California Medical Group, a California Medical Par
- Bonnie Rettgers, AUD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.