Samantha Shalika Wettimuny, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY25004 Issued in CA

Practice address

3208 Rosemead Blvd
Suite 200
El Monte, CA 91731-2830

Phone

(626) 227-7014

Fax

(626) 227-7015

NPI assigned

Jan 23, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343779200000",
    "number": "1861546152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3208 ROSEMEAD BLVD",
            "address_2": "SUITE 200",
            "city": "EL MONTE",
            "state": "CA",
            "postal_code": "917312830",
            "telephone_number": "626-227-7014",
            "fax_number": "626-227-7015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3208 ROSEMEAD BLVD",
            "address_2": "SUITE 200",
            "city": "EL MONTE",
            "state": "CA",
            "postal_code": "917312830",
            "telephone_number": "626-227-7014",
            "fax_number": "626-227-7015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WETTIMUNY",
        "first_name": "SAMANTHA",
        "middle_name": "SHALIKA",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-23",
        "last_updated": "2012-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY25004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in El Monte, CA
• Providers in El Monte, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.