Healthcare Provider Details

I. General information

NPI: 1952771735
Provider Name (Legal Business Name): EMPRESS INSIGHTS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2015
Last Update Date: 04/06/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 NEWPORT CENTER DR SUITE 1
NEWPORT BEACH CA
92660-7506
US

IV. Provider business mailing address

220 NEWPORT CENTER DR SUITE 1
NEWPORT BEACH CA
92660-7506
US

V. Phone/Fax

Practice location:
  • Phone: 714-497-3519
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY26514
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPSY26514
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY26514
License Number StateCA

VIII. Authorized Official

Name: ALINA GRAM
Title or Position: DIRECTOR
Credential:
Phone: 714-497-3519