Healthcare Provider Details

I. General information

NPI: 1396201273
Provider Name (Legal Business Name): CENTER FOR INTEGRATIVE HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2019
Last Update Date: 02/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 CORPORATE PLAZA DR STE 150
NEWPORT BEACH CA
92660-7908
US

IV. Provider business mailing address

23 CORPORATE PLAZA DR STE 150
NEWPORT BEACH CA
92660-7908
US

V. Phone/Fax

Practice location:
  • Phone: 949-945-9120
  • Fax:
Mailing address:
  • Phone: 949-945-9120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. EILEEN PANIAGUA
Title or Position: CLINICAL AND RESEARCH DIRECTOR
Credential: PSY.D.
Phone: 949-945-9120