MEDICARE: CALIFORNIA PSYCHIATRIC 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

General Provider Information

NPI Number	:	1427499094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALIFORNIA PSYCHIATRIC SPECIALISTS

Provider Business Mailing Address
First Line	:	PO BOX 6646
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92863-6646
Country	:	US
Telephone Number	:	888-217-5353
Fax Number	:	714-464-2215

Provider Business Practice Location Address
First Line	:	405 14TH ST STE 711
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94612-2706
Country	:	US
Telephone Number	:	888-217-5353
Fax Number	:	714-464-2215

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JEFFERY GOULD
Credential	:	M.D.
Telephone Number	:	888-217-5353

Provider Enumeration Date	:	07/11/2013
Last Update Date	:	07/11/2013

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