Healthcare Provider Details

I. General information

NPI: 1033067400
Provider Name (Legal Business Name): SOCAL MIND AND BODY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 03/20/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 IRON HORSE
IRVINE CA
92602-1826
US

IV. Provider business mailing address

127 IRON HORSE
IRVINE CA
92602-1826
US

V. Phone/Fax

Practice location:
  • Phone: 720-697-4025
  • Fax:
Mailing address:
  • Phone: 720-697-4025
  • Fax: 949-694-2696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. TODD TRACY IGNAT
Title or Position: CLINICAL DIRECTOR
Credential: NP
Phone: 720-697-4025