Unknown Individual – Clinical Psychologist, NPI 1669525028

Unknown Individual is a healthcare provider. based in Coronado, California. specializing in Clinical Psychologist. They hold a License No. PSY 12657 (CA). The NPI Number for Unknown Individual is 1669525028

Main info

Organization
Inactive
37 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1669525028
Phone
(619) 435-8308
Address
830 ORANGE AVE
Deactivation Date
27 March 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
6194358308
Graduation Year
1989 (37 years ago)
PAC ID
1456458041
Professional Enrollment ID
I20070515000673
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • Orange Avenue, Coronado, San Diego County, California, 92152, United States

    STE. A2

    CORONADO, CA 921182658

    Phone: (619) 435-8308

    Fax: (619) 437-1406

    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.

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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)

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

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

Insurance plans in this area (ZIP 92118)

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Reviews

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Frequently asked questions

How do payers reference Unknown Individual?
For Unknown Individual, use NPI 1669525028 as the unique 10-digit identifier.
Is inactive the same as retired for Unknown Individual?
Inactive registry status can reflect deactivation, consolidation, or data lag.
What expertise is attributed to Unknown Individual?
Unknown Individual's specialty line reads Clinical Psychologist. Clinical services aligned with this taxonomy classification.
Is Unknown Individual located near Coronado?
Unknown Individual currently maps to Coronado, California in this extract.
Does Unknown Individual accept insurance?
Insurance participation is not part of the core NPI extract — call the plan or office to confirm.

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