Healthcare Provider Details

I. General information

NPI: 1497558654
Provider Name (Legal Business Name): SAIKAYA TREE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 STEVENS AVE STE 206
SOLANA BEACH CA
92075-2065
US

IV. Provider business mailing address

462 STEVENS AVE STE 310
SOLANA BEACH CA
92075-2066
US

V. Phone/Fax

Practice location:
  • Phone: 858-298-3599
  • Fax:
Mailing address:
  • Phone: 858-610-1601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: THEODORE GERMANOS
Title or Position: CEO
Credential: MD
Phone: 858-610-1601