| Ophelia Medical Group Ca, P.c. | |
|
6920 Miramar Road Suite 329 San Diego CA 92121-2642 | |
| (215) 585-2144 | |
| (267) 780-7032 |
| Full Name | Ophelia Medical Group Ca, P.c. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 6920 Miramar Road, San Diego, California |
| Authorized Official Name and Position | Arthur R Williams (OWNER) |
| Authorized Official Contact | 3478578015 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ophelia Medical Group Ca, P.c. 228 Park Ave S Ste 15314 New York NY 10003-1502 Ph: (215) 585-2144 | Ophelia Medical Group Ca, P.c. 6920 Miramar Road Suite 329 San Diego CA 92121-2642 Ph: (215) 585-2144 |
| NPI Number | 1760153381 |
|---|---|
| Provider Enumeration Date | 09/23/2021 |
| Last Update Date | 03/18/2024 |
| Certification Date | 03/18/2024 |
| Medicare PECOS PAC ID | 5294126587 |
|---|---|
| Medicare Enrollment ID | O20220421001174 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760153381 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084A0401X | Psychiatry & Neurology - Addiction Medicine | (* (Not Available)) | Primary |
| Provider Name | Arielle Bivas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841607314 PECOS PAC ID: 8820390503 Enrollment ID: I20160112003031 |
| Provider Name | Brittany Angelica Jarrell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558781112 PECOS PAC ID: 3173836921 Enrollment ID: I20190613001823 |
| Provider Name | Arthur Robinson Williams |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1063739985 PECOS PAC ID: 3072928480 Enrollment ID: I20220425002715 |
| Provider Name | Adam Bisaga |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1023135613 PECOS PAC ID: 4183025802 Enrollment ID: I20220713001852 |
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