Active NPI
Makayla Grimmer
- Licensed Psychiatric Technician
- Hesperia, CA
National Provider Identifier
1700537925
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Psychiatric Technician
- License
- 40565
- Practice address
- 11776 Mariposa Rd # 103
Hesperia, CA 92345-1622 - Phone
- (760) 956-2462
- NPI assigned
- Jan 11, 2022
- 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 |
|---|---|---|---|---|
| Licensed Psychiatric Technician | 167G00000X | 40565 | CA | Primary |
Addresses
Primary practice location
11776 Mariposa Rd # 103
Hesperia, CA 92345-1622
Mailing address
7428 Nielson Rd
Phelan, CA 92371-6854
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40565 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aegis Treatment Centers, LLC | 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.
-
- Methadone Clinic
- Hesperia, CA
- NPI 1215373055
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1641859200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1643241600000",
"number": "1700537925",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7428 NIELSON RD",
"city": "PHELAN",
"state": "CA",
"postal_code": "923716854"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11776 MARIPOSA RD # 103",
"city": "HESPERIA",
"state": "CA",
"postal_code": "923451622",
"telephone_number": "760-956-2462"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRIMMER",
"first_name": "MAKAYLA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-01-11",
"last_updated": "2022-01-27",
"certification_date": "2022-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "167G00000X",
"taxonomy_group": "",
"desc": "Licensed Psychiatric Technician",
"state": "CA",
"license": "40565",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hesperia, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.