Organization Active NPI

Village Medical Group

  • Pediatric Occupational Therapist
  • Los Angeles, CA
National Provider Identifier
1760289656
Registry record updated Feb 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Occupational TherapistTaxonomy code 225XP0200X
Legal business name
VILLAGE MEDICAL GROUP
Practice address
8109 McConnell Ave
Los Angeles, CA 90045-2717
Phone
(213) 340-2947
NPI assigned
Feb 27, 2025
Last updated
Feb 27, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2025

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

Authorized official

Name
Brandon Terry
Title
Operations Administrator
Phone
(831) 915-7443

Specialties & licenses 15

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent Psychologist 103TC2200X
Intellectual & Developmental Disabilities Psychologist 103TM1800X
Clinical Social Worker 1041C0700X
Pediatric Nutrition Registered Dietitian 133VN1004X
Pediatrics Physician 208000000X
Developmental - Behavioral Pediatrics Physician 2080P0006X
Pediatric Neurodevelopmental Disabilities Physician 2080P0008X
Pediatric Rehabilitation Medicine Physician 2081P0010X
Pediatric Physical Therapist 2251P0200X
Pediatric Occupational Therapist 225XP0200X Primary
Speech-Language Pathologist 235Z00000X
Behavior Analyst 103K00000X
Pediatric Sleep Medicine Physician 2080S0012X
Assistant Behavior Analyst 106E00000X
Behavior Technician 106S00000X

Addresses

Primary practice location

8109 McConnell Ave
Los Angeles, CA 90045-2717

Mailing address

2261 Market St Ste 86187
San Francisco, CA 94114-1612
Phone (213) 340-2947

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1740614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740614400000",
    "number": "1760289656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2261 MARKET ST STE 86187",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941141612",
            "telephone_number": "213-340-2947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8109 MCCONNELL AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900452717",
            "telephone_number": "213-340-2947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLAGE MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-27",
        "last_updated": "2025-02-27",
        "certification_date": "2025-02-26",
        "status": "A",
        "authorized_official_last_name": "TERRY",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_title_or_position": "OPERATIONS ADMINISTRATOR",
        "authorized_official_telephone_number": "831-915-7443"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TM1800X",
            "taxonomy_group": "",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133VN1004X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Pediatric",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0006X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0008X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neurodevelopmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2081P0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080S0012X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Sleep Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106E00000X",
            "taxonomy_group": "",
            "desc": "Assistant Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2025; 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.