Healthcare Provider Details

I. General information

NPI: 1386146496
Provider Name (Legal Business Name): ALLIANCE PSYCHIATRIC GROUP INC A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2018
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2082 BUSINESS CENTER DR STE 255
IRVINE CA
92612-1162
US

IV. Provider business mailing address

PO BOX 6040
IRVINE CA
92616-6040
US

V. Phone/Fax

Practice location:
  • Phone: 714-769-6090
  • Fax:
Mailing address:
  • Phone: 714-769-6090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95003733
License Number StateCA

VIII. Authorized Official

Name: MOSES MORAR
Title or Position: PARTNER
Credential: NP
Phone: 949-574-3341