Healthcare Provider Details

I. General information

NPI: 1730764192
Provider Name (Legal Business Name): DAVID C.D. OH PMHNP - BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2021
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 BARRANCA PKWY STE 260
IRVINE CA
92604-4780
US

IV. Provider business mailing address

4040 BARRANCA PKWY STE 260
IRVINE CA
92604-4780
US

V. Phone/Fax

Practice location:
  • Phone: 925-282-1778
  • Fax: 415-296-5299
Mailing address:
  • Phone: 925-282-1778
  • Fax: 415-296-5299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number811664
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95015845
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: