Healthcare Provider Details

I. General information

NPI: 1750081493
Provider Name (Legal Business Name): GUARDIAN HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 BRISTOL ST STE H201
COSTA MESA CA
92626-7917
US

IV. Provider business mailing address

2900 BRISTOL ST STE H201
COSTA MESA CA
92626-7917
US

V. Phone/Fax

Practice location:
  • Phone: 714-375-1110
  • Fax: 714-242-9700
Mailing address:
  • Phone: 714-375-1110
  • Fax: 714-242-9700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN WOODFORD SMITH
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 949-892-3020