Individual provider Active NPI

Damiana Rodriguez

  • Psychiatric/Mental Health Nurse Practitioner
  • Redlands, CA
National Provider Identifier
1922885979
Registry record updated Jul 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
95026909 Issued in CA
Practice address
1809 W Redlands Blvd
Redlands, CA 92373-8054
Phone
(909) 289-4075
Fax
(909) 363-8233
NPI assigned
Sep 13, 2023
Last updated
Jul 9, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 95026909 CA Primary
Registered Nurse 163W00000X 95215526 CA

Addresses

Primary practice location

1809 W Redlands Blvd
Redlands, CA 92373-8054

Mailing address

3210 Long Beach Blvd
Long Beach, CA 90807-5062
Phone (562) 548-6500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241009000469 CA Practitioner - Nurse Practitioner 0840721254 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1809 W Redlands Blvd
Redlands, CA 92373-8054
Phone (909) 335-3026

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95026909CAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Inland Psychiatric Medical Group, Inc. Psychiatric/Mental Health CurrentSince Sep 1, 2024 Accepting new patients
Inland Psychiatric Medical Group, Inc. Psychiatric/Mental Health Current Accepting new patients
Inland Psychiatric Medical Group, Inc. PastSince Apr 6, 2025 Accepting new patients

Locations

5475 Walnut Ave
Chino, CA 91710
Phone (909) 591-6446

81709 Doctor Carreon Blvd
Ste C1
Indio, CA 92201
Phone (760) 330-5161

23110 Atlantic Cir
Ste F
Moreno Valley, CA 92553
Phone (951) 243-6455

73345 Highway 111
Ste 203
Palm Desert, CA 92260
Phone (760) 340-3158

73700 Dinah Shore Dr
Ste 106
Palm Desert, CA 92211
Phone (760) 832-6352

8710 Monroe Ct
Ste 150
Rancho Cucamonga, CA 91730
Phone (909) 941-4870

1809 W Redlands Blvd
Redlands, CA 92373
Phone (909) 307-1320

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1694563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720483200000",
    "number": "1922885979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3210 LONG BEACH BLVD",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908075062",
            "telephone_number": "562-548-6500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1809 W REDLANDS BLVD",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923738054",
            "telephone_number": "909-289-4075",
            "fax_number": "909-363-8233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "DAMIANA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-13",
        "last_updated": "2024-07-09",
        "certification_date": "2024-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95026909",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "95215526",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Redlands, CA

Sources for this page

Verify at the official NPI Registry.