Pacifica Neuropsychology Center

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

PSY 19781 Issued in CA

Legal business name

PACIFICA NEUROPSYCHOLOGY CENTER

Practice address

461 W 6TH St, Suite 211
San Pedro, CA 90731-2694

Phone

(310) 547-0084

Fax

(310) 833-5672

NPI assigned

Sep 2, 2011

Organization subpart

No

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

Authorized official

Name

Marisa Mares, PH.DNPI 1033203054

Title

Clinical Director

Phone

(310) 547-0084

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Tax ID family

Pacifica Neuropsychology Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Pacifica Neuropsychology Center, Inc

  • Mental Health Counselor
  • San Pedro, CA
  • NPI 1558808667
  NPD tax ID

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Marisa Mares, PH.D.

  • Clinical Neuropsychologist
  • San Pedro, CA
  • NPI 1033203054
  Medicare reassignment Authorized official
• Justin Bret Ayres, LMFT

  • Marriage & Family Therapist
  • San Pedro, CA
  • NPI 1083896013
  NPD (past)
• Ana Maria De la Torre, PH.D.

  • Clinical Psychologist
  • San Pedro, CA
  • NPI 1932281698
  NPD (past)

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

{
    "created_epoch": "1314921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485388800000",
    "number": "1962783951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "461 W 6TH ST, SUITE 211",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907312694",
            "telephone_number": "310-547-0084",
            "fax_number": "310-833-5672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "461 W 6TH ST, SUITE 211",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907312694",
            "telephone_number": "310-547-0084",
            "fax_number": "310-833-5672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFICA NEUROPSYCHOLOGY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-02",
        "last_updated": "2017-01-26",
        "status": "A",
        "authorized_official_last_name": "MARES",
        "authorized_official_first_name": "MARISA",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "310-547-0084",
        "authorized_official_credential": "PH.D"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "CA",
            "license": "PSY 19781",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "MFC 42200",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan Lynette Owen, M.F.T.
• Patricia Owens
• Mika Ozawa, M.A.
• Luis Hernan Pacheco
• Pacific View
• Pacifica Neuropsychology Center, Inc
• Aaron Michael Pak, DC
• Doris Z Pakozdi-Past, LMFT
• Frances Marie Palomarez
• Panbehi Anesthesia Services, Inc.

• Clinical Neuropsychologist in San Pedro, CA
• Providers in San Pedro, CA by specialty
• Clinical Neuropsychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.