Healthcare Provider Details

I. General information

NPI: 1063044410
Provider Name (Legal Business Name): PACIFIC COAST PSYCHIATRIC ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4540 KEARNY VILLA RD STE 103
SAN DIEGO CA
92123-1564
US

IV. Provider business mailing address

490 POST ST STE 1043
SAN FRANCISCO CA
94102-1301
US

V. Phone/Fax

Practice location:
  • Phone: 858-259-1223
  • Fax: 858-467-7161
Mailing address:
  • Phone: 925-231-4325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANISHA PATEL-DUNN
Title or Position: CEO
Credential:
Phone: 415-409-0944