Marianna Deromedi, PT

Primary specialty

Licensed Psychiatric TechnicianTaxonomy code 167G00000X

License

PT28474 Issued in CA

Practice address

2975 McMillan Ave Ste 164
San Luis Obispo, CA 93401-6768

Phone

(805) 439-4890

NPI assigned

Jun 19, 2007

Last updated

Dec 19, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1182211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734566400000",
    "number": "1952506073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8625 CARMELITA AVE",
            "city": "ATASCADERO",
            "state": "CA",
            "postal_code": "934223976",
            "telephone_number": "805-466-2821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2975 MCMILLAN AVE STE 164",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934016768",
            "telephone_number": "805-439-4890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEROMEDI",
        "first_name": "MARIANNA",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-19",
        "last_updated": "2024-12-19",
        "certification_date": "2024-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "167G00000X",
            "taxonomy_group": "",
            "desc": "Licensed Psychiatric Technician",
            "state": "CA",
            "license": "PT28474",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Licensed Psychiatric Technician in San Luis Obispo, CA
• Providers in San Luis Obispo, CA by specialty
• Licensed Psychiatric Technician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2024; 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.