Healthcare Provider Details

I. General information

NPI: 1912637521
Provider Name (Legal Business Name): PACIFIC COGNITIVE HEALTH, A PROFESSIONAL PSYCHOLOGICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3626 SACRAMENTO ST STE 4
SAN FRANCISCO CA
94118-1720
US

IV. Provider business mailing address

PO BOX 210160
SAN FRANCISCO CA
94121-0160
US

V. Phone/Fax

Practice location:
  • Phone: 352-340-3897
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL MANGAL
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 352-340-3897