Kim Cardilla, PH.D.

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

PSY29537 Issued in CA

Practice address

740 Front St Ste 320
Santa Cruz, CA 95060-4536

Phone

(831) 710-1455

Fax

(888) 617-7565

NPI assigned

Jan 8, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1515369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1515369600000",
    "number": "1891202255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "740 FRONT ST STE 320",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950604536",
            "telephone_number": "831-710-1455",
            "fax_number": "888-617-7565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "740 FRONT ST STE 320",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950604536",
            "telephone_number": "831-710-1455",
            "fax_number": "888-617-7565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARDILLA",
        "first_name": "KIM",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-01-08",
        "last_updated": "2018-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "CA",
            "license": "PSY29537",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY29537",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Neuropsychologist in Santa Cruz, CA
• Providers in Santa Cruz, CA by specialty
• Clinical Neuropsychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2018; 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.