Healthcare Provider Details

I. General information

NPI: 1316416670
Provider Name (Legal Business Name): PSYCHIATRIC EXCELLENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2018
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 N SEPULVEDA BLVD # 2012
LOS ANGELES CA
90049-2185
US

IV. Provider business mailing address

651 N SEPULVEDA BLVD # 2012
LOS ANGELES CA
90049-2185
US

V. Phone/Fax

Practice location:
  • Phone: 858-386-2322
  • Fax:
Mailing address:
  • Phone: 858-386-2322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ANURAG GOEL
Title or Position: CEO
Credential: MD
Phone: 858-386-2322