Healthcare Provider Details

I. General information

NPI: 1528068707
Provider Name (Legal Business Name): SOCAL BEHAVIORAL HEALTH PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 PARKCENTER DR SUITE 206
SANTA ANA CA
92705-3522
US

IV. Provider business mailing address

601 PARKCENTER DR SUITE 206
SANTA ANA CA
92705-3522
US

V. Phone/Fax

Practice location:
  • Phone: 714-453-0688
  • Fax: 714-453-0691
Mailing address:
  • Phone: 714-453-0688
  • Fax: 714-453-0691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2780787
License Number StateCA

VIII. Authorized Official

Name: DR. GEOFFREY B. PHILLIPS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-453-0688