Active NPI
Rose Bazakas, PHD
- Psychologist
- Laguna Hills, CA
National Provider Identifier
1679644041
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY19971
- Practice address
- 23151 Moulton Pkwy
Laguna Hills, CA 92653 - Phone
- (949) 951-2077
- Fax
- (949) 587-5768
- NPI assigned
- Nov 10, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY19971 | CA | Primary |
Addresses
Primary practice location
23151 Moulton Pkwy
Laguna Hills, CA 92653
Mailing address
23151 Moulton Pkwy
Laguna Hills, CA 92653
Phone (949) 951-2077
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY19971 | CA | MD | Psychologist |
| 000843 | CT | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163116800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1679644041",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23151 MOULTON PKWY",
"city": "LAGUNA HILLS",
"state": "CA",
"postal_code": "92653",
"telephone_number": "949-951-2077",
"fax_number": "949-587-5768"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23151 MOULTON PKWY",
"city": "LAGUNA HILLS",
"state": "CA",
"postal_code": "92653",
"telephone_number": "949-951-2077",
"fax_number": "949-587-5768"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAZAKAS",
"first_name": "ROSE",
"name_prefix": "Mrs.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY19971",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Laguna Hills, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.