Healthcare Provider Details

I. General information

NPI: 1750143376
Provider Name (Legal Business Name): DR. ANISSA YORK, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SONOMA AISLE
IRVINE CA
92618-3911
US

IV. Provider business mailing address

2234 N FEDERAL HWY # 1214
BOCA RATON FL
33431-7710
US

V. Phone/Fax

Practice location:
  • Phone: 619-333-3963
  • Fax:
Mailing address:
  • Phone: 619-333-3963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ANISSA YORK
Title or Position: PRESIDENT
Credential: PSY.D.
Phone: 619-333-3963