Healthcare Provider Details

I. General information

NPI: 1356685218
Provider Name (Legal Business Name): PACIFIC NEUROPSYCHIATRIC SPECIALISTS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3151 AIRWAY AVE STE G1
COSTA MESA CA
92626-4624
US

IV. Provider business mailing address

3151 AIRWAY AVE STE G1
COSTA MESA CA
92626-4624
US

V. Phone/Fax

Practice location:
  • Phone: 714-545-5550
  • Fax: 714-708-2588
Mailing address:
  • Phone: 714-545-5550
  • Fax: 714-708-2588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALEJANDRO ALVA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-545-5550