Healthcare Provider Details

I. General information

NPI: 1457793671
Provider Name (Legal Business Name): SOUTH COAST PSYCHIATRIC ADVANCED NURSING PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 07/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 W BALL RD SUITE 100B
ANAHEIM CA
92804-3738
US

IV. Provider business mailing address

3400 W BALL RD SUITE 100B
ANAHEIM CA
92804-3738
US

V. Phone/Fax

Practice location:
  • Phone: 714-484-4900
  • Fax: 714-484-4903
Mailing address:
  • Phone: 714-484-4900
  • Fax: 714-484-4903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number16553
License Number StateCA

VIII. Authorized Official

Name: MRS. GEORGETA LAURA DRANCEA
Title or Position: PRESIDENT
Credential: NP
Phone: 714-484-4900