Individual provider Active NPI

Jessica Katheryn Bonette

  • Marriage & Family Therapist
  • Irvine, CA
National Provider Identifier
1972679538
Registry record updated Nov 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
67413 IMF Issued in CA
Practice address
19742 Macarthur Blvd Ste 100
Irvine, CA 92612-2408
Phone
(714) 646-8034
Fax
(714) 492-8264
NPI assigned
Nov 27, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 67413 IMF CA Primary

Addresses

Primary practice location

19742 Macarthur Blvd Ste 100
Irvine, CA 92612-2408

Mailing address

18200 Yorba Linda Blvd Ste 111
Yorba Linda, CA 92886-4043
Phone (714) 646-8034

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240115000919 CA Practitioner - Marriage and Family Therapist 0749632800 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Chiron Psychological IncGroup PAC ID 9234496308, 15 clinicians

Practice addresses (Care Compare)

19742 Macarthur Blvd
Suite 135
Irvine, CA 92612-2430
Phone (714) 646-8034

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
67413 IMFCAMDMarriage & Family Therapist

Organizations & group practices 1

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": "1164585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699315200000",
    "number": "1972679538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18200 YORBA LINDA BLVD STE 111",
            "city": "YORBA LINDA",
            "state": "CA",
            "postal_code": "928864043",
            "telephone_number": "714-646-8034",
            "fax_number": "714-492-8264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19742 MACARTHUR BLVD STE 100",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926122408",
            "telephone_number": "714-646-8034",
            "fax_number": "714-492-8264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONETTE",
        "first_name": "JESSICA",
        "middle_name": "KATHERYN",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-27",
        "last_updated": "2023-11-07",
        "certification_date": "2023-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "67413 IMF",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Irvine, CA

Sources for this page

Verify at the official NPI Registry.