Healthcare Provider Details

I. General information

NPI: 1154864874
Provider Name (Legal Business Name): CENTER FOR NEUROHEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2016
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4180 LA JOLLA VILLAGE DR STE 240
LA JOLLA CA
92037
US

IV. Provider business mailing address

4180 LA JOLLA VILLAGE DR STE 240
LA JOLLA CA
92037-1471
US

V. Phone/Fax

Practice location:
  • Phone: 866-277-2659
  • Fax: 858-779-2511
Mailing address:
  • Phone: 866-277-2659
  • Fax: 858-779-2511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License NumberA124696
License Number StateCA

VIII. Authorized Official

Name: ALEXANDRA ORLIAC
Title or Position: GENERAL COUNSEL
Credential:
Phone: 866-447-2551