Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 2084P0804X | Psychiatry & Neurology | Child & Adolescent Psychiatry | 45105 | WISCONSIN | No |
| 2 | 2084P0804X | Psychiatry & Neurology | Child & Adolescent Psychiatry | ME105882 | FLORIDA | No |
| 3 | 2084P0804X | Psychiatry & Neurology | Child & Adolescent Psychiatry | G88381 | CALIFORNIA | No |
| 4 | 2084P0804X | Psychiatry & Neurology | Child & Adolescent Psychiatry | 2015-01804 | NORTH CAROLINA | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | FHC 70044F | OTHER | CALIFORNIA | COUNTY OF SANTA CRUZ MEDI-CAL GROUP# |
| 2 | ZZZ91891Z | OTHER | CALIFORNIA | COUNTY OF SANTA CRUZ MEDICARE GROUP PTAN# |
| 3 | CA116297 | OTHER | CALIFORNIA | SANTA CRUZ COUNTY MEDICARE PTAN# |
| 4 | CA116296 | OTHER | CALIFORNIA | SANTA CRUZ COUNTY MEDICARE PTAN# |
| 5 | FHC 70042 | OTHER | CALIFORNIA | COUNTY OF SANTA CRUZ MEDI-CAL GROUP# |
| 6 | ZZZ91892Z | OTHER | CALIFORNIA | COUNTY OF SANTA CRUZ MEDICARE GROUP PTAN# |
| 7 | 34296500 | MEDICAID | WISCONSIN | |
| 8 | 001782300 | MEDICAID | FLORIDA | |
| 9 | CA116295 | OTHER | CALIFORNIA | SANTA CRUZ COUNTY MEDICARE PTAN# |
| 10 | ZZZ92069Z | OTHER | CALIFORNIA | COUNTY OF SANTA CRUZ MEDICARE GROUP PTAN# |
