Healthcare Provider Details

I. General information

NPI: 1295242410
Provider Name (Legal Business Name): DYLAN GUINEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 01/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17782 COWAN STE A
IRVINE CA
92614-6041
US

IV. Provider business mailing address

9735 PORT ROYAL CIR
HUNTINGTON BEACH CA
92646-7520
US

V. Phone/Fax

Practice location:
  • Phone: 949-722-7118
  • Fax:
Mailing address:
  • Phone: 714-290-3396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95030727
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95008466
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: