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General NPI Number Information
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NPI Number | 1407950058
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Entity Type | Organization
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Legal Business Name | PSYCHIATRIC & COUNSELING MEDICAL CLINICS, INC.
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Dates
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Enumeration Date | 09/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1830 COMMERCENTER E
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3406
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Country | US
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Telephone | 909-885-5608
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Fax | 909-889-7096
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Provider Business Mailing Address
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Address Line | PO BOX 6306
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City | SAN BERNARDINO
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State | CA
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Zip | 92412-6306
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Country | US
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Telephone | 909-885-5608
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Fax | 909-889-7096
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SUNIL PAUL DESILVA
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Credential | M.D.
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Telephone | 909-885-5608
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A29608
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License Number State | CA
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