Individual provider Active NPI

Vanessa Cruz Fontes, PSYD

  • Clinical Psychologist
  • Rancho Cordova, CA
National Provider Identifier
1730337775
Registry record updated Nov 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY25388 Issued in CA
Practice address
10725 International Dr
Rancho Cordova, CA 95670-7967
Phone
(916) 631-3000
NPI assigned
Sep 3, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY25388 CA Primary

Addresses

Primary practice location

10725 International Dr
Rancho Cordova, CA 95670-7967

Mailing address

10725 International Dr
Rancho Cordova, CA 95670-7967
Phone (916) 631-3000

Other identifiers 1

IdentifierTypeStateIssuer
TFC2578OtherCALOS ANGELES COUNTY DEPARTMENT OF MENTAL HEALTH

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

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
I20130813000768 CA Practitioner - Clinical Psychologist 3971745498 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Apr 1, 2020 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Permanente Medical Group Inc CurrentSince Jun 16, 2013 Accepting new patients
Southern California Permanente Medical Group CurrentSince Apr 1, 2020 Accepting new patients
Permanente Medical Group, Inc CurrentSince Jun 16, 2013 Accepting new patients
Permanente Medical Group Inc Current Accepting new patients

Locations

9961 Sierra Ave
Fontana, CA 92335
Phone (909) 427-3910

1150 Veterans Blvd
Redwood City, CA 94063
Phone (650) 299-2015

901 Nevin Ave
Richmond, CA 94801
Phone (510) 307-1500

10725 International Dr
Rncho Cordova, CA 95670
Phone (916) 631-2060

2200 Ofarrell St
San Francisco, CA 94115
Phone (415) 202-2000

710 Lawrence Expy
Santa Clara, CA 95051
Phone (408) 236-6400

7373 West Ln
Stockton, CA 95210
Phone (209) 476-2000

975 Sereno Dr
Vallejo, CA 94589
Phone (707) 651-1000

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1220400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638230400000",
    "number": "1730337775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10725 INTERNATIONAL DR",
            "city": "RANCHO CORDOVA",
            "state": "CA",
            "postal_code": "956707967",
            "telephone_number": "916-631-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10725 INTERNATIONAL DR",
            "city": "RANCHO CORDOVA",
            "state": "CA",
            "postal_code": "956707967",
            "telephone_number": "916-631-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONTES",
        "first_name": "VANESSA",
        "middle_name": "CRUZ",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-03",
        "last_updated": "2021-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY25388",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LOS ANGELES COUNTY DEPARTMENT OF MENTAL HEALTH",
            "identifier": "TFC2578",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "9961 Sierra Ave",
            "city": "Fontana",
            "state": "CA",
            "country_code": "US",
            "postal_code": "923356720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Rancho Cordova, CA

Sources for this page

Verify at the official NPI Registry.