Pacific Stone Psychology Corporation

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

Legal business name

PACIFIC STONE PSYCHOLOGY CORPORATION

Practice address

264 Clovis Ave # 104
Clovis, CA 93612-1115

Phone

(559) 777-9061

NPI assigned

May 10, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Heather Pedersen, PHDNPI 1083032635

Title

Owner / Neuropsychologist

Phone

(559) 777-9061

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Heather Pedersen, PH.D.

  • Clinical Neuropsychologist
  • Clovis, CA
  • NPI 1083032635
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1620604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620604800000",
    "number": "1770167371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "264 CLOVIS AVE # 104",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936121115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "264 CLOVIS AVE # 104",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936121115",
            "telephone_number": "559-777-9061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC STONE PSYCHOLOGY CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-10",
        "last_updated": "2021-05-10",
        "certification_date": "2021-05-10",
        "status": "A",
        "authorized_official_last_name": "PEDERSEN",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_title_or_position": "OWNER / NEUROPSYCHOLOGIST",
        "authorized_official_telephone_number": "559-777-9061",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hpedersen@pacificstoneneuropsychology.com",
            "affiliation": "N",
            "endpointDescription": "Office location",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "264 Clovis Ave # 104",
            "city": "Clovis",
            "state": "CA",
            "country_code": "US",
            "postal_code": "936121115",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lilianna Oviedo Trujillo
• Ozder Dental Corporation
• Ozder Dental Corporation
• Erica Pacheco
• Myrna Pacheco, MS
• Carlo Magno Arriba Paderna, D.D.S.
• Brenda Padilla
• Jesse Anthony Padilla
• Eric L Pagenkopf, M.D.
• Aashita Pahwa, LMFT

• Clinical Neuropsychologist in Clovis, CA
• Providers in Clovis, CA by specialty
• Clinical Neuropsychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.