Individual provider Active NPI

Sandra Nunez, MFT

  • Marriage & Family Therapist
  • La Jolla, CA
National Provider Identifier
1861785859
Registry record updated Aug 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
LMFT 84299 Issued in CA
Practice address
4275 Executive SQ Ste 200
La Jolla, CA 92037-1476
Phone
(619) 481-1725
Fax
(619) 860-1285
NPI assigned
May 24, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X IMF 63684 CA
Marriage & Family Therapist 106H00000X LMFT 84299 CA Primary

Addresses

Primary practice location

4275 Executive SQ Ste 200
La Jolla, CA 92037-1476

Mailing address

4275 Executive SQ Ste 200
La Jolla, CA 92037-1476
Phone (619) 481-1725

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, CO2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20250212001527 CA Practitioner - Marriage and Family Therapist 8325578933 Reassigns benefits to 1 organization
I20250213001224 CO Practitioner - Marriage and Family Therapist 8325578933 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
IMF 63684CAMDMarriage & Family Therapist
LMFT 84299CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Grow Healthcare Group PA Marriage & Family Therapist CurrentSince Jan 7, 2025 Accepting new patients
Grow Healthcare Group PC Marriage & Family Therapist CurrentSince Jan 3, 2025 Accepting new patients
Psychiatric Centers at San Diego, Inc. Med GRP Marriage & Family Therapist PastSince Feb 25, 2019 Accepting new patients

Locations

99 Almaden Blvd
Ste 600
San Jose, CA 95113
Phone (408) 402-4385

5445 Dtc Pkwy
Ph 4
Greenwood Village, CO 80111
Phone (720) 571-4874

66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 3

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": "1306195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659484800000",
    "number": "1861785859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4275 EXECUTIVE SQ STE 200",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920371476",
            "telephone_number": "619-481-1725",
            "fax_number": "619-860-1285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4275 EXECUTIVE SQ STE 200",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920371476",
            "telephone_number": "619-481-1725",
            "fax_number": "619-860-1285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NUNEZ",
        "first_name": "SANDRA",
        "credential": "MFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-05-24",
        "last_updated": "2022-08-03",
        "certification_date": "2022-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "IMF 63684",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "LMFT 84299",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Jolla, CA

Sources for this page

Verify at the official NPI Registry.