Active NPI
Jeffry Clary Warren, PHD
- Psychologist
- La Jolla, CA
National Provider Identifier
1700496080
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 5689
- Practice address
- 1224 Prospect St Ste 100
La Jolla, CA 92037-3609 - Phone
- (858) 454-0576
- NPI assigned
- Aug 3, 2020
- Last updated
- Aug 3, 2020
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 5689 | CA | Primary |
Addresses
Primary practice location
1224 Prospect St Ste 100
La Jolla, CA 92037-3609
Mailing address
1224 Prospect St Ste 100
La Jolla, CA 92037-3609
Phone (858) 454-0576
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)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5689 | CA | MD | Case Manager/Care Coordinator |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1596412800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1596412800000",
"number": "1700496080",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1224 PROSPECT ST STE 100",
"city": "LA JOLLA",
"state": "CA",
"postal_code": "920373609",
"telephone_number": "858-454-0576"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1224 PROSPECT ST STE 100",
"city": "LA JOLLA",
"state": "CA",
"postal_code": "920373609",
"telephone_number": "858-454-0576"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WARREN",
"first_name": "JEFFRY",
"middle_name": "CLARY",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-08-03",
"last_updated": "2020-08-03",
"certification_date": "2020-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "5689",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Jolla, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.