Individual provider Active NPI

Dyane Jonette Lemos, PH.D.

  • Clinical Psychologist
  • San Diego, CA
National Provider Identifier
1780729095
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY12975 Issued in CA
Practice address
2220 5TH Ave
San Diego, CA 92101-2104
Phone
(619) 491-9424
Fax
(619) 230-1066
NPI assigned
Feb 21, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY12975 CA Primary

Addresses

Primary practice location

2220 5TH Ave
San Diego, CA 92101-2104

Mailing address

2220 5TH Ave
San Diego, CA 92101-2104
Phone (619) 491-9424

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120308000155 CA Practitioner - Clinical Psychologist 0840459087 Practice locations: San Diego, CA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2220 5TH Ave
San Diego, CA 92101-2104
Phone (619) 491-9424

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSY12975CAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Diet Free Solution a Psychological Corp Clinical PastSince May 1, 2022 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1780729095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2220 5TH AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921012104",
            "telephone_number": "619-491-9424",
            "fax_number": "619-230-1066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2220 5TH AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921012104",
            "telephone_number": "619-491-9424",
            "fax_number": "619-230-1066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEMOS",
        "first_name": "DYANE",
        "middle_name": "JONETTE",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY12975",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.