Individual provider Active NPI

Keri Ann Prins Abdullah, PH.D.

  • Clinical Psychologist
  • San Diego, CA
National Provider Identifier
1699840587
Registry record updated Aug 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
29990 Issued in CA
Practice address
10717 Camino Ruiz Ste 207
San Diego, CA 92126-2364
Phone
(858) 695-2211
NPI assigned
Nov 23, 2006
Last updated
Aug 24, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Clinical Psychologist 103TC0700X 29990 CA Primary

Addresses

Primary practice location

10717 Camino Ruiz Ste 207
San Diego, CA 92126-2364

Mailing address

10717 Camino Ruiz Ste 207
San Diego, CA 92126-2364
Phone (858) 695-2211

Other practice location 1

2136 El Cajon Blvd
San Diego, CA 92104-1102
Phone (619) 906-5319

Other names 1

  • Keri A Abdullah Other name

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
I20180503002147 CA Practitioner - Clinical Psychologist 8426312182 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3514 30TH St
San Diego, CA 92104-4120
Phone (619) 515-2424

3544 30TH St
San Diego, CA 92104-4120
Phone (619) 515-2424

3705 Mission Blvd
San Diego, CA 92109-7104
Phone (619) 515-2444

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
29990CAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Family Health Centers of San Diego, Inc CurrentSince May 22, 2020 Accepting new patients
Family Health Centers of San Diego, Inc CurrentSince May 22, 2020 Accepting new patients
Family Health Centers of San Diego, Inc Current Accepting new patients
Community Research Foundation Inc PastSince Apr 1, 2018 Accepting new patients

Locations

2136 El Cajon Blvd
San Diego, CA 92104
Phone (619) 291-1881

3544 30th St
San Diego, CA 92104
Phone (619) 515-2424

823 Gateway Center Way
San Diego, CA 92102
Phone (619) 515-2323

Organizations & group practices 5

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

NPI Registry JSON

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

{
    "created_epoch": "1164240000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692835200000",
    "number": "1699840587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10717 CAMINO RUIZ STE 207",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921262364",
            "telephone_number": "858-695-2211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10717 CAMINO RUIZ STE 207",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921262364",
            "telephone_number": "858-695-2211"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2136 El Cajon Blvd",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921041102",
            "country_code": "US",
            "telephone_number": "619-906-5319",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ABDULLAH",
        "first_name": "KERI",
        "middle_name": "ANN PRINS",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-23",
        "last_updated": "2023-08-24",
        "certification_date": "2023-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "29990",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KERI",
            "last_name": "ABDULLAH",
            "middle_name": "A",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.