Oak Leaf Psychiatry Inc

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

OAK LEAF PSYCHIATRY INC

Practice address

200 E del Mar Blvd
Pasadena, CA 91105-2544

Phone

(626) 569-8074

NPI assigned

Feb 22, 2021

Organization subpart

No

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

Authorized official

Name

Edgardo Jorge Menvielle, MDNPI 1053405985

Title

Owner

Phone

(626) 569-8074

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Edgardo Menvielle

  • Psychiatry Physician
  • Pasadena, CA
  • NPI 1053405985
  NPD Authorized official

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

{
    "created_epoch": "1613952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613952000000",
    "number": "1700470697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 E DEL MAR BLVD",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911052544",
            "telephone_number": "626-569-8074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 E DEL MAR BLVD",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911052544",
            "telephone_number": "626-569-8074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OAK LEAF PSYCHIATRY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-22",
        "last_updated": "2021-02-22",
        "certification_date": "2021-01-25",
        "status": "A",
        "authorized_official_last_name": "MENVIELLE",
        "authorized_official_first_name": "EDGARDO",
        "authorized_official_middle_name": "JORGE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "626-569-8074",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon Couture O'Flinn, PH.D.
• Kyle Thomas O'Meara, MD
• Adam Michael O'Toole, M.D.
• Martin A. O'Toole, M.D.
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• Oakpark Surgery Center
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• Psychiatry Physician in Pasadena, CA
• Providers in Pasadena, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.