Healthcare Provider Details

I. General information

NPI: 1831159003
Provider Name (Legal Business Name): THE DEPARTMENT OF PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S BLDG 3
ORANGE CA
92868
US

IV. Provider business mailing address

PO BOX 31001-2473
PASADENA CA
91110-2473
US

V. Phone/Fax

Practice location:
  • Phone: 949-824-1283
  • Fax: 949-824-9891
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. UCI HEALTH PROVIDER RELATIONS
Title or Position: US PROVIDER RELATIONS
Credential:
Phone: 714-456-2986