Healthcare Provider Details

I. General information

NPI: 1700643111
Provider Name (Legal Business Name): HOMECOMING PSYCHIATRY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2024
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S COAST DR APT F206
COSTA MESA CA
92626-7740
US

IV. Provider business mailing address

301 BAYVIEW CIR STE 104
NEWPORT BEACH CA
92660-2948
US

V. Phone/Fax

Practice location:
  • Phone: 714-386-9766
  • Fax:
Mailing address:
  • Phone: 714-386-9766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANAM GULRAIZ
Title or Position: CEO
Credential: PMHNP-BC
Phone: 714-386-9766