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 | 103TA0400X | Psychologist | Addiction (Substance Use Disorder) | 14246 | CALIFORNIA | No |
| 2 | 103TB0200X | Psychologist | Cognitive & Behavioral | PSY14246 | CALIFORNIA | No |
| 3 | 103TP2701X | Psychologist | Group Psychotherapy | PSY14246 | CALIFORNIA | No |
| 4 | 207LA0401X | Anesthesiology | Addiction Medicine | G52483 | CALIFORNIA | No |
| 5 | 207LP2900X | Anesthesiology | Pain Medicine | | | No |
| 6 | 207RA0401X | Internal Medicine | Addiction Medicine | G52483 | CALIFORNIA | No |
| 7 | 2081P2900X | Physical Medicine & Rehabilitation | Pain Medicine | G52483 | CALIFORNIA | No |
| 8 | 2084A0401X | Psychiatry & Neurology | Addiction Medicine | G12893 | CALIFORNIA | No |
| 9 | 2084P2900X | Psychiatry & Neurology | Pain Medicine | G12893 | CALIFORNIA | No |
| 10 | 208VP0000X | Pain Medicine | Pain Medicine | G52483 | CALIFORNIA | No |
| 11 | 208VP0014X | Pain Medicine | Interventional Pain Medicine | G52483 | CALIFORNIA | No |
| 12 | 225700000X | Massage Therapist | | | | No |
| 13 | 261QP2300X | Clinic/Center | Primary Care | | | No |
| 14 | 261QP3300X | Clinic/Center | Pain | | | Yes |
