Healthcare Provider Details

I. General information

NPI: 1952724817
Provider Name (Legal Business Name): PACIFIC NEUROBEHAVIORAL CLINIC: A PSYCHOLOGICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2014
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3990 OLD TOWN AVE STE C303
SAN DIEGO CA
92110-2932
US

IV. Provider business mailing address

3990 OLD TOWN AVE STE C303
SAN DIEGO CA
92110-2932
US

V. Phone/Fax

Practice location:
  • Phone: 858-964-0722
  • Fax: 866-437-0375
Mailing address:
  • Phone: 858-964-0722
  • Fax: 866-437-0375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberPSY22738
License Number StateCA

VIII. Authorized Official

Name: ALEXIS OLSON BACHIEGA
Title or Position: CEO
Credential: PHD
Phone: 858-964-0722