Active NPI
Kaddy Revolorio, PSY.D.
- Psychologist
- North Hills, CA
National Provider Identifier
1962707422
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- Practice address
- 16111 Plummer St
North Hills, CA 91343 - Phone
- (818) 891-7711
- NPI assigned
- Jan 13, 2011
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | Primary |
Addresses
Primary practice location
16111 Plummer St
North Hills, CA 91343
Mailing address
16111 Plummer St
North Hills, CA 91343-2036
Other practice location 1
1000 W Carson St
Torrance, CA 90502-2004
Phone (310) 222-1636
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1294876800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1590710400000",
"number": "1962707422",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16111 PLUMMER ST",
"city": "NORTH HILLS",
"state": "CA",
"postal_code": "913432036"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16111 PLUMMER ST",
"city": "NORTH HILLS",
"state": "CA",
"postal_code": "91343",
"telephone_number": "818-891-7711"
}
],
"practiceLocations": [
{
"address_1": "1000 W Carson St",
"address_purpose": "LOCATION",
"city": "Torrance",
"state": "CA",
"postal_code": "905022004",
"country_code": "US",
"telephone_number": "310-222-1636",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "REVOLORIO",
"first_name": "KADDY",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-01-13",
"last_updated": "2020-05-29",
"certification_date": "2020-05-29",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Hills, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.