Healthcare Provider Details

I. General information

NPI: 1528485679
Provider Name (Legal Business Name): ADRIAN JACQUES HALCYON AMBROSE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2014
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S MAIN ST STE 209
CORONA CA
92882-3401
US

IV. Provider business mailing address

19782 MACARTHUR BLVD STE 300
IRVINE CA
92612-2417
US

V. Phone/Fax

Practice location:
  • Phone: 714-545-5550
  • Fax: 949-991-2040
Mailing address:
  • Phone: 714-545-5550
  • Fax: 949-991-2040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberC193525
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: