Healthcare Provider Details

I. General information

NPI: 1871097311
Provider Name (Legal Business Name): CHELSEA BY THE SEA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 03/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10211 KUKUI DR
HUNTINGTON BEACH CA
92646-2518
US

IV. Provider business mailing address

10211 KUKUI DR
HUNTINGTON BEACH CA
92646-2518
US

V. Phone/Fax

Practice location:
  • Phone: 714-356-2664
  • Fax:
Mailing address:
  • Phone: 714-356-2664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: LAURA CHAKALIAN
Title or Position: OWNER
Credential:
Phone: 714-356-2664