Active NPI
Samuel W. Mulembo
- Clinical Psychologist
- Monrovia, CA
National Provider Identifier
1902923873
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY10165
- Practice address
- 902 S Myrtle Ave
Monrovia, CA 91016-3427 - Phone
- (626) 303-1541
- Fax
- (626) 599-9928
- NPI assigned
- Mar 23, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY10165 | CA | Primary |
Addresses
Primary practice location
902 S Myrtle Ave
Monrovia, CA 91016-3427
Mailing address
2650 E del Mar Blvd
Pasadena, CA 91107-4817
Phone (626) 579-8087
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9594126299 | Other | CA | TAX ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY10165 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174608000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1370476800000",
"number": "1902923873",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2650 E DEL MAR BLVD",
"city": "PASADENA",
"state": "CA",
"postal_code": "911074817",
"telephone_number": "626-579-8087"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "902 S MYRTLE AVE",
"city": "MONROVIA",
"state": "CA",
"postal_code": "910163427",
"telephone_number": "626-303-1541",
"fax_number": "626-599-9928"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MULEMBO",
"first_name": "SAMUEL",
"middle_name": "W.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-23",
"last_updated": "2013-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY10165",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "9594126299",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Monrovia, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.