Unknown Individual – Clinical Neuropsychologist, NPI 1174540645

Unknown Individual is a healthcare provider. based in Atascadero, California. specializing in Clinical Neuropsychologist. They hold a License No. PSY 5273 (CA). The NPI Number for Unknown Individual is 1174540645

Main info

Organization
Inactive
51 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1174540645
Phone
(805) 466-5641
Address
10420 EL CAMINO REAL
Deactivation Date
20 September 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
8054665641
Graduation Year
1975 (51 years ago)
PAC ID
5395910459
Professional Enrollment ID
I20111219000767
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience24
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • Dr. Peter Russell PhD, 10420, El Camino Real, Atascadero, San Luis Obispo County, California, 93423, United States

    ATASCADERO, CA 934226882

    Phone: (805) 466-5641

    Fax: (805) 466-2989

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

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Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

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No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 93422)

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Reviews

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Frequently asked questions

What is Unknown Individual's NPI number?
Unknown Individual's NPI is 1174540645 — the number used across U.S. healthcare to identify this provider.
Is inactive the same as retired for Unknown Individual?
Inactive registry status can reflect deactivation, consolidation, or data lag.
What kind of doctor is Unknown Individual?
Unknown Individual is associated with Clinical Neuropsychologist in the directory — Clinical services aligned with this taxonomy classification.
Is Unknown Individual associated with Atascadero?
Public fields place Unknown Individual around Atascadero, California. Always confirm the exact site before visiting.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.