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1427110816 NPI number — JERRY AUGUSTINE DIREGOLO PHD

NPI Number: 1427110816
Health Care Provider/Practitioner: JERRY AUGUSTINE DIREGOLO PHD

Information about “1427110816” NPI (JERRY AUGUSTINE DIREGOLO PHD) exists in 1427110816 in HTML format HTML  |  1427110816 in plain Text format TXT  |  1427110816 in PDF (Portable Document Format) PDF  |  1427110816 in an XML format XML  formats.

NPI Number : 1427110816 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1427110816",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DIREGOLO",
    "FirstName": "JERRY",
    "MiddleName": "AUGUSTINE",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PHD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "DIREGOLO",
    "OtherFirstName": "JEROLD",
    "OtherMiddleName": "AUGUSTINE",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "PHD",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "1600 EUREKA RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ROSEVILLE",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "95661-3027",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "916-771-7610",
    "MailingAddressFaxNumber": "916-771-7650",
    "FirstLinePracticeLocationAddress": "1600 EUREKA RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ROSEVILLE",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "95661-3027",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "916-771-7610",
    "PracticeLocationAddressFaxNumber": "916-771-7650",
    "EnumerationDate": "12/14/2006",
    "LastUpdateDate": "09/11/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "103TC0700X",
          "TaxonomyName": "Clinical Psychologist",
          "LicenseNumber": "PSY4274",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103TC2200X",
          "TaxonomyName": "Clinical Child & Adolescent Psychologist",
          "LicenseNumber": "PSY4274",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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