Healthcare Provider Details

I. General information

NPI: 1912699703
Provider Name (Legal Business Name): MYNDFULL CARE CALIFORNIA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8445 CAMINO SANTA FE STE 215
SAN DIEGO CA
92121-2650
US

IV. Provider business mailing address

8445 CAMINO SANTA FE STE 215
SAN DIEGO CA
92121-2650
US

V. Phone/Fax

Practice location:
  • Phone: 855-839-8878
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TEJA SINGH
Title or Position: MD
Credential: OWNERS
Phone: 855-839-8878