Healthcare Provider Details

I. General information

NPI: 1285523936
Provider Name (Legal Business Name): SOCAL PSYCH SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/30/2025
Certification Date: 06/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1665 UNION ST STE A
SAN DIEGO CA
92101-2906
US

IV. Provider business mailing address

1199 PACIFIC HWY UNIT 1606
SAN DIEGO CA
92101-8419
US

V. Phone/Fax

Practice location:
  • Phone: 619-663-5344
  • Fax: 619-373-9206
Mailing address:
  • Phone: 559-579-8343
  • Fax: 619-373-9206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY FAM
Title or Position: CEO
Credential: MD
Phone: 559-579-8343