Healthcare Provider Details

I. General information

NPI: 1174987119
Provider Name (Legal Business Name): HEAL PSYCHIATRIC SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 06/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 S AMPHLETT BLVD SUITE 301
SAN MATEO CA
94402-2703
US

IV. Provider business mailing address

1710 S AMPHLETT BLVD SUITE 301
SAN MATEO CA
94402-2703
US

V. Phone/Fax

Practice location:
  • Phone: 650-273-4082
  • Fax: 650-275-7559
Mailing address:
  • Phone: 650-273-4082
  • Fax: 650-275-7559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA95033
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA95033
License Number StateCA

VIII. Authorized Official

Name: DR. FARZANA AMIN
Title or Position: C.E.O.
Credential: M.D.
Phone: 650-273-4082