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General NPI Number Information
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NPI Number | 1104330570
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Entity Type | Organization
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Legal Business Name | INTEGRATED PSYCHIATRY, INC.
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Dates
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Enumeration Date | 11/21/2017
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Last Update Date | 02/04/2020
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Provider Practice Location Address
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Address Line | 25000 AVENUE STANFORD STE 173
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City | VALENCIA
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State | CA
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Zip | 91355-4596
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Country | US
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Telephone | 818-927-0688
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Fax | 818-888-5982
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Provider Business Mailing Address
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Address Line | 27943 SECO CANYON RD # 573
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City | SANTA CLARITA
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State | CA
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Zip | 91350-3872
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Country | US
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Telephone | 818-927-0688
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Fax | 866-543-9915
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Authorized Official
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Title or Position | PRESIDENT
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Name | LOURDES GRAYSON
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Credential | MD
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Telephone | 818-927-0688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number | A111804
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084P0005X
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Taxonomy Name | Neurodevelopmental Disabilities Physician
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License Number | A111804
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A111804
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | A111804
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License Number State | CA
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