MEDICARE: PACIFIC NEUROPSYCHIATRIC SPECIALISTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	A062396	CA

General Provider Information

NPI Number	:	1144376435
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC NEUROPSYCHIATRIC SPECIALISTS

Provider Business Mailing Address
First Line	:	3151 AIRWAY AVE STE T3
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-4627
Country	:	US
Telephone Number	:	949-545-5550
Fax Number	:	949-545-5748

Provider Business Practice Location Address
First Line	:	3151 AIRWAY AVE STE T3
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-4627
Country	:	US
Telephone Number	:	949-545-5550
Fax Number	:	949-545-5748

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALEJANDRO ALVA
Credential	:	M.D.
Telephone Number	:	949-545-5550

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	07/11/2008

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