Healthcare Provider Details

I. General information

NPI: 1851763098
Provider Name (Legal Business Name): PSISTEMA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2015
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4882 E GAYANN DR
ANAHEIM CA
92807-3005
US

IV. Provider business mailing address

PO BOX 28701
ANAHEIM CA
92809-0156
US

V. Phone/Fax

Practice location:
  • Phone: 714-624-8018
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number72445
License Number StateCA

VIII. Authorized Official

Name: JESSICA MARTINEZ
Title or Position: DIRECTOR
Credential:
Phone: 714-624-8018