Healthcare Provider Details

I. General information

NPI: 1174069439
Provider Name (Legal Business Name): OSCAR H. OO, PSY.D. A PROFESSIONAL PSYCHOLOGICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2017
Last Update Date: 12/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 MACARTHUR BLVD SUITE 600, EAST TOWER
NEWPORT BEACH CA
92660-2558
US

IV. Provider business mailing address

4000 MACARTHUR BLVD SUITE 600, EAST TOWER
NEWPORT BEACH CA
92660-2558
US

V. Phone/Fax

Practice location:
  • Phone: 949-648-3704
  • Fax: 714-352-6471
Mailing address:
  • Phone: 949-648-3704
  • Fax: 714-352-6471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY22699
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 22699
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY 22699
License Number StateCA

VIII. Authorized Official

Name: DR. OSCAR OO
Title or Position: PRESIDENT
Credential: PSY.D.
Phone: 949-648-3704