Active NPI
Lidia Balderas Medrano
- School Psychologist
- San Diego, CA
National Provider Identifier
1770155780
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- Practice address
- 402 W Broadway Ste 1925
San Diego, CA 92101-8505 - Phone
- (619) 322-5078
- NPI assigned
- Jul 11, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | Primary |
Addresses
Primary practice location
402 W Broadway Ste 1925
San Diego, CA 92101-8505
Mailing address
402 W Broadway Ste 1925
San Diego, CA 92101-8505
Phone (619) 746-7031
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1625961600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686614400000",
"number": "1770155780",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "402 W BROADWAY STE 1925",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921018505",
"telephone_number": "619-746-7031"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "402 W BROADWAY STE 1925",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921018505",
"telephone_number": "619-322-5078"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDRANO",
"first_name": "LIDIA",
"middle_name": "BALDERAS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-07-11",
"last_updated": "2023-06-13",
"certification_date": "2023-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"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 Jun 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.