Healthcare Provider Details

I. General information

NPI: 1720605249
Provider Name (Legal Business Name): ALOHA PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2020
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 HOLMES PL
TUSTIN CA
92782-3738
US

IV. Provider business mailing address

1968 S COAST HWY # 2093
LAGUNA BEACH CA
92651-3681
US

V. Phone/Fax

Practice location:
  • Phone: 808-304-0406
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JONATHAN ALABANZA SY
Title or Position: CEO
Credential: MD
Phone: 808-304-0406