Healthcare Provider Details

I. General information

NPI: 1689064594
Provider Name (Legal Business Name): UCR HEALTH - PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2015
Last Update Date: 01/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17782 COWAN SUITE A
IRVINE CA
92614-6030
US

IV. Provider business mailing address

PO BOX 31001-2130
PASADENA CA
91110-2130
US

V. Phone/Fax

Practice location:
  • Phone: 951-827-7964
  • Fax: 951-263-7238
Mailing address:
  • Phone: 213-412-1973
  • Fax: 213-412-1981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JOHN A HEYDT
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MD
Phone: 714-456-2986