Individual provider Active NPI

Benjamin Metta Penhas, PSYD

  • Psychologist
  • San Diego, CA
National Provider Identifier
1770037632
Registry record updated Oct 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Practice address
9666 Businesspark Ave
San Diego, CA 92131-1646
Phone
(619) 600-0073
NPI assigned
Aug 9, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 32888 CA
Psychologist 103T00000X Primary

Addresses

Primary practice location

9666 Businesspark Ave
San Diego, CA 92131-1646

Mailing address

4745 W Park Blvd
Ste113-1058
Plano, TX 75093-2329

Other practice location 1

4745 w park blvd
ste113-1058
plano, TX 75093-2329
Phone (858) 208-0877

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

LicenseStateTypeSpecialty
32888CAMDRecreation Therapist

NPI Registry JSON

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

{
    "created_epoch": "1470700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761782400000",
    "number": "1770037632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4745 W PARK BLVD",
            "address_2": "STE113-1058",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750932329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9666 BUSINESSPARK AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921311646",
            "telephone_number": "619-600-0073"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4745 w park blvd",
            "address_2": "ste113-1058",
            "address_purpose": "LOCATION",
            "city": "plano",
            "state": "TX",
            "postal_code": "750932329",
            "country_code": "US",
            "telephone_number": "858-208-0877",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "METTA PENHAS",
        "first_name": "BENJAMIN",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-08-09",
        "last_updated": "2025-10-30",
        "certification_date": "2025-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "32888",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 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.