MEDICARE: ENHANCED PSYCHOLOGICAL HEALTH CARE, INC

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	103TC0700X	Clinical Psychologist	PSY9899	CA

General Provider Information

NPI Number	:	1588029045
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENHANCED PSYCHOLOGICAL HEALTH CARE, INC

Provider Business Mailing Address
First Line	:	5737 TRINITY PL
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-4549
Country	:	US
Telephone Number	:	619-265-8383
Fax Number	:	619-460-2100

Provider Business Practice Location Address
First Line	:	5737 TRINITY PL
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-4549
Country	:	US
Telephone Number	:	619-265-8383
Fax Number	:	619-460-2100

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MS. FARIDEH HASSANI REZAI
Credential	:	PH.D
Telephone Number	:	619-265-8383

Provider Enumeration Date	:	12/28/2015
Last Update Date	:	05/14/2025

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