Healthcare Provider Details

I. General information

NPI: 1114482635
Provider Name (Legal Business Name): CRITICAL CARE PSYCHOLOGICAL SPECIALISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2019
Last Update Date: 03/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W STEWART DR
ORANGE CA
92868-3849
US

IV. Provider business mailing address

63 VIA MARBRISA
SAN CLEMENTE CA
92673-5685
US

V. Phone/Fax

Practice location:
  • Phone: 714-633-9111
  • Fax:
Mailing address:
  • Phone: 714-571-5000
  • Fax: 714-571-5055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: AMANDA ZINTSMASTER
Title or Position: PRESIDENT
Credential: PSYD
Phone: 714-571-5000