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NPI 1053609834ActiveIndividual· Psychologist· San Jose, CA
Psychologist with County of Santa Clara, practicing in San Jose, California. Enrolled in Medicare as practitioner - clinical psychologist. Lists Santa Clara Valley Medical Center as a hospital affiliation.
Overview
| NPI | 1053609834 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Sole proprietor | Yes |
| NPI issued | Jul 14, 2011 |
| Last updated in NPPES | Dec 1, 2017 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Psychologist Primary | 103T00000X | — | — |
| Psychologist, Clinical | 103TC0700X | PSY26861 | CA |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Clinical Psychologist (CA) |
|---|
Education and affiliations
| Graduation year | 2013 |
|---|---|
| Medicare specialty | Clinical Psychologist |
Medical group
- County of Santa ClaraSan Jose, CA · 1,022 clinicians
Hospital affiliation
- Santa Clara Valley Medical CenterSan Jose, CA
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All 185 psychologists in San Jose · All psychologists in California