Healthcare Provider Details

I. General information

NPI: 1053771782
Provider Name (Legal Business Name): PACIFIC SOLSTICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2016
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26732 CROWN VALLEY PKWY STE 443
MISSION VIEJO CA
92691-6375
US

IV. Provider business mailing address

26732 CROWN VALLEY PKWY STE 443
MISSION VIEJO CA
92691-6375
US

V. Phone/Fax

Practice location:
  • Phone: 949-402-9520
  • Fax: 949-506-3716
Mailing address:
  • Phone: 949-402-9520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number300636AP
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: BRITTEN THERESE DEVEREUX
Title or Position: ADMINISTRATOR
Credential: LADAC
Phone: 949-200-7929