Individual provider Active NPI

Wendi Maurer, PH.D.

  • Clinical Psychologist
  • La Jolla, CA
National Provider Identifier
1679596282
Registry record updated Feb 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY 12694 Issued in CA
Practice address
3252 Holiday CT
Suite 220
La Jolla, CA 92037-0027
Phone
(619) 491-3459
Fax
(858) 453-8634
NPI assigned
Jul 25, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 21, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY 12694 CA Primary

Addresses

Primary practice location

3252 Holiday CT
Suite 220
La Jolla, CA 92037-0027

Mailing address

8813 Villa la Jolla Dr
Ste 2002
La Jolla, CA 92037-1927
Phone (619) 491-3459

Other identifiers 1

IdentifierTypeStateIssuer
PSY126940MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040511000861 CA Practitioner - Clinical Psychologist 8325037682 Practice locations: La Jolla, CA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

3252 Holiday CT
Suite 105
La Jolla, CA 92037-1807
Phone (619) 701-7999

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSY 12694CAMDClinical Psychologist
12694CAMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Richard M. Wachsman, M.D. a Medical Corporation Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1519171200000",
    "number": "1679596282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8813 VILLA LA JOLLA DR",
            "address_2": "STE 2002",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920371927",
            "telephone_number": "619-491-3459",
            "fax_number": "858-453-8634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3252 HOLIDAY CT",
            "address_2": "SUITE 220",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920370027",
            "telephone_number": "619-491-3459",
            "fax_number": "858-453-8634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAURER",
        "first_name": "WENDI",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-25",
        "last_updated": "2018-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY 12694",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PSY126940",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in La Jolla, CA

Sources for this page

Verify at the official NPI Registry.