Individual provider Active NPI

Tara Codee Mauro, D.O.

  • Psychiatry Physician
  • San Diego, CA
National Provider Identifier
1962508903
Registry record updated May 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
20A16439 Issued in CA
Practice address
11515 El Camino Real Ste 100
San Diego, CA 92130-3034
Phone
(858) 279-1223
Fax
(858) 261-2001
NPI assigned
Sep 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 20A16439 CA Primary

Addresses

Primary practice location

11515 El Camino Real Ste 100
San Diego, CA 92130-3034

Mailing address

11515 El Camino Real Ste 100
San Diego, CA 92130-3034
Phone (858) 279-1223

Other names 1

  • Tara Codee Long Former name

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190506000480 CA Practitioner - Psychiatry 5193950384 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
University of Pikeville, Kentucky College of Osteopathic Med, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Pacific Coast Psychiatric Associates IncGroup PAC ID 2567469174, 637 clinicians

Practice addresses (Care Compare)

11515 El Camino Real
Suite 100
San Diego, CA 92130-3034
Phone (858) 279-1223

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
20A16439CAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pacific Coast Psychiatric Associates Inc Psychiatry CurrentSince Aug 14, 2023 Accepting new patients
Psycare Inc CurrentSince Apr 2, 2019 Accepting new patients

Locations

1720 El Camino Real
Ste 140
Burlingame, CA 94010

2300 Boswell Rd
Ste 275
Chula Vista, CA 91914
Phone (585) 898-0612

1480 64th St
Ste 150
Emeryville, CA 94608
Phone (415) 296-5292

2365 Iron Point Rd
Ste 210
Folsom, CA 95630
Phone (925) 360-5264

4040 Barranca Pkwy
Ste 260
Irvine, CA 92604

8881 Fletcher Pkwy
Ste 350
La Mesa, CA 91942
Phone (619) 465-9792

6200 Wilshire Blvd
Ste 1410
Los Angeles, CA 90048
Phone (323) 403-0474

4361 Latham St
Ste 220
Riverside, CA 92501
Phone (206) 906-5385

5222 Pirrone Ct
Ste 101A
Salida, CA 95368

4540 Kearny Villa Rd
Ste 103
San Diego, CA 92123
Phone (858) 259-1223

11515 El Camino Real
Ste 100
San Diego, CA 92130
Phone (858) 256-8674

12264 El Camino Real
Ste 203
San Diego, CA 92130

4550 Kearny Villa Rd
Ste 116
San Diego, CA 92123
Phone (619) 279-1223

490 Post St
Ste 1043
San Francisco, CA 94102
Phone (415) 409-0944

1245 S Winchester Blvd
Ste 110
San Jose, CA 95128
Phone (415) 296-5299

Interoperability endpoints

  • Direct secure messaging: psycareassociates.taramauro@143255.advancedmd-direct.com

Organizations & group practices 2

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": "1158364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715817600000",
    "number": "1962508903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11515 EL CAMINO REAL STE 100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921303034",
            "telephone_number": "858-279-1223",
            "fax_number": "858-261-2001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11515 EL CAMINO REAL STE 100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921303034",
            "telephone_number": "858-279-1223",
            "fax_number": "858-261-2001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAURO",
        "first_name": "TARA",
        "middle_name": "CODEE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-16",
        "last_updated": "2024-05-16",
        "certification_date": "2024-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "20A16439",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TARA",
            "last_name": "LONG",
            "middle_name": "CODEE",
            "credential": "D.O.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.