Healthcare Provider Details

I. General information

NPI: 1790235422
Provider Name (Legal Business Name): ACCESS MIND INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2016
Last Update Date: 10/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30101 TOWN CENTER DR STE 113
LAGUNA NIGUEL CA
92677-5028
US

IV. Provider business mailing address

30101 TOWN CENTER DR STE 113
LAGUNA NIGUEL CA
92677-5028
US

V. Phone/Fax

Practice location:
  • Phone: 949-257-3637
  • Fax:
Mailing address:
  • Phone: 949-257-3637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD GRANESE
Title or Position: MEDICAL DIRECTOR
Credential: M.D.,MBA
Phone: 949-257-3637