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General NPI Number Information
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NPI Number | 1801751615
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Entity Type | Organization
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Legal Business Name | PACIFICA BRAIN HEALTH RESIDENCY PROGRAM
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Dates
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Enumeration Date | 12/23/2025
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Last Update Date | 12/23/2025
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Provider Practice Location Address
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Address Line | 14541 DELANO ST
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City | VAN NUYS
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State | CA
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Zip | 91411-2820
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Country | US
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Telephone | 310-597-2081
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Fax |
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Provider Business Mailing Address
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Address Line | 18430 BROOKHURST ST STE 202E
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City | FOUNTAIN VLY
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State | CA
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Zip | 92708-6762
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Country | US
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Telephone | 310-597-2081
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. EKRAM YACOUB
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Credential |
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Telephone | 310-597-2081
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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