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General NPI Number Information
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NPI Number | 1346628179
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Entity Type | Organization
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Legal Business Name | ORCHID HEALTHCARE INC
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Dates
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Enumeration Date | 05/13/2015
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Last Update Date | 05/13/2015
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Provider Practice Location Address
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Address Line | 15373 INNOVATION DRIVE, STE 395
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City | SAN DIEGO
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State | CA
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Zip | 92128-3429
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Country | US
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Telephone | 858-876-3105
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Fax | 858-876-3107
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Provider Business Mailing Address
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Address Line | 15373 INNOVATION DRIVE, STE 395
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City | SAN DIEGO
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State | CA
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Zip | 92128-3429
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Country | US
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Telephone | 858-876-3105
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Fax | 858-876-3107
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SATYA V TATA
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Credential | M.D.
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Telephone | 858-876-3105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PSY25897
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT84598
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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 | A98273
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License Number State | CA
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