Travis Dauntia Fultz, PSYD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY 19419 Issued in CA

Practice address

13193 Central Avenue
Suite 200
Chino, CA 91710

Phone

(909) 902-9111

Fax

(909) 902-9199

NPI assigned

Nov 18, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Specialty

Clinical Psychologist

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Foothills Psychological Services IncGroup PAC ID 9436157534, 37 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Foothills Psychological Services, Inc.

  • Psychologist
  • Upland, CA
  • NPI 1336121888
  Medicare reassignment Care Compare group NPD
• Mission City Community Network, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Hollywood, CA
  • NPI 1710102009
  Medicare reassignment NPD
• One Health Center, Inc.

  • Community Health Clinic/Center
  • Upland, CA
  • NPI 1265272736
  Medicare reassignment
• Mission City Community Network, Inc.

  • Community Health Clinic/Center
  • North Hills, CA
  • NPI 1710370747
  NPD

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

{
    "created_epoch": "1132272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1831171388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13193 CENTRAL AVENUE",
            "address_2": "SUITE 200",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "91710",
            "telephone_number": "909-902-9111",
            "fax_number": "909-902-9199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13193 CENTRAL AVENUE",
            "address_2": "SUITE 200",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "91710",
            "telephone_number": "909-902-9111",
            "fax_number": "909-902-9199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULTZ",
        "first_name": "TRAVIS",
        "middle_name": "DAUNTIA",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY 19419",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PSY 194190",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fred Armogida
• Emily Frigaard
• Cameron Frye, AMFT
• Emily Fu, M.D.
• Mao-Jin Fu, M.D.
• Neeru Kaur Gaetano, PA
• Raymond Galadari, PHARMACIST
• Leslie Ann Villavicencio Galang
• Geanie Danielle Galindo, MSN, FNP
• Fernando Alfonso Galvez Coronel, M.D.

• Psychologist in Chino, CA
• Providers in Chino, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.