San Quentin

Primary specialty

Case Management AgencyTaxonomy code 251B00000X

Legal business name

SAN QUENTIN

Practice address

1635 Josephine St
Berkeley, CA 94703-1320

Phone

(415) 454-1469

NPI assigned

Jul 29, 2013

Organization subpart

No

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

Authorized official

Name

Mr. Christopher Roach, PSYCH. D

Title

Supervisor

Phone

(415) 454-1460

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1375056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375056000000",
    "number": "1710329925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1635 JOSEPHINE ST",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947031320",
            "telephone_number": "415-454-1469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1635 JOSEPHINE ST",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947031320",
            "telephone_number": "415-454-1469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN QUENTIN",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-29",
        "last_updated": "2013-07-29",
        "status": "A",
        "authorized_official_last_name": "ROACH",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "SUPERVISOR",
        "authorized_official_telephone_number": "415-454-1460",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PSYCH. D"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LCSW",
            "identifier": "LCS14462",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joshua John Samuel, M.D.
• Tamar Leah Jehan Samuels, RDN
• San Jose Audiology, a Professional Corporation
• Darlyn Motas San Jose, OTR/L
• Michelle Milanes San Jose, M.S.W., BCBA
• Susan Thompson San Tara, MFT
• Liliana Sanchez Coronado, MS, CCC-SLP
• Jessica Xcarlet Sanchez
• Rocio Sanchez
• Erda Sanders, D.C.

• Case Management Agency in Berkeley, CA
• Providers in Berkeley, CA by specialty
• Case Management Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2013; 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.