Active NPI
Village Medical Group
- Pediatric Occupational Therapist
- Los Angeles, CA
National Provider Identifier
1760289656
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- 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, 2025
- Organization subpart
- No
NPPES NPI Registry
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) | Code | License | State | Primary |
|---|---|---|---|---|
| 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 DirectoryNPI 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.