Clarissa Gonzalez-Idiart, PH.D.

Key facts

NPI

1831553890

Entity type

Individual (NPI type 1)

Primary specialty

Forensic Psychologist 103TF0200X

Practice address

23370 Road 22
Chowchilla, CA 93610-8504

Phone

(559) 665-5531

NPI assigned

Apr 6, 2016

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Doctor of Philosophy

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 6, 2016.

{
    "created_epoch": "1459900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459900800000",
    "number": "1831553890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23370 ROAD 22",
            "city": "CHOWCHILLA",
            "state": "CA",
            "postal_code": "936108504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23370 ROAD 22",
            "city": "CHOWCHILLA",
            "state": "CA",
            "postal_code": "936108504",
            "telephone_number": "559-665-5531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ-IDIART",
        "first_name": "CLARISSA",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-06",
        "last_updated": "2016-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TF0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Forensic",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CDCR",
            "identifier": "1417318569",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chowchilla, CA

• Delaney Ann Gilman
• Christopher Glass, PSY.D.
• Mariela Gomez Garcia, PSYD
• Patricia Gomez, LCSW
• Babette Joyce Gonzales de Garcia, LPT
• Danielle Rene Gonzalez, LCSW
• Jessica Gonzalez
• Kimberly Gragston, ASW
• Yasmin Griselda Granados
• Kirenjot Grewal, MS

All providers in Chowchilla, CA · Forensic Psychologist in California