| Orange Psychiatric Medical Group, Inc | |
|
770 Magnolia Ave Suite 1f Corona CA 92879-3121 | |
| (951) 737-1917 | |
| (951) 735-4105 |
| Full Name | Orange Psychiatric Medical Group, Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 770 Magnolia Ave, Corona, California |
| Authorized Official Name and Position | Sai B Chundu (PRESIDENT/ OWNER) |
| Authorized Official Contact | 9517371917 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Orange Psychiatric Medical Group, Inc 770 Magnolia Ave Suite 1f Corona CA 92879-3121 Ph: (951) 737-1917 | Orange Psychiatric Medical Group, Inc 770 Magnolia Ave Suite 1f Corona CA 92879-3121 Ph: (951) 737-1917 |
| NPI Number | 1225383763 |
|---|---|
| Provider Enumeration Date | 07/20/2012 |
| Last Update Date | 07/20/2012 |
| Medicare PECOS PAC ID | 2668623562 |
|---|---|
| Medicare Enrollment ID | O20121126000504 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225383763 | NPI | - | NPPES |
| Provider Name | Julie G Wareham |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1801853114 PECOS PAC ID: 9638082522 Enrollment ID: I20070622000566 |
| Provider Name | Rahima Afghan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1023060449 PECOS PAC ID: 9234218314 Enrollment ID: I20080430000417 |
| Provider Name | Juvvala M Reddy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1205919503 PECOS PAC ID: 9436297298 Enrollment ID: I20091116000337 |
| Provider Name | Sai B Chundu |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1609968460 PECOS PAC ID: 7719890607 Enrollment ID: I20100610000311 |
| Provider Name | Rajababu Kurre |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1376584680 PECOS PAC ID: 8426224254 Enrollment ID: I20111229000186 |
| Provider Name | Renu R Shishodia |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1386785962 PECOS PAC ID: 4688827389 Enrollment ID: I20130109000038 |
| Provider Name | Aletha Alice Herron |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437269503 PECOS PAC ID: 8729204847 Enrollment ID: I20140728000036 |
| Provider Name | Tahja Psyd Mcdowell |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1346578184 PECOS PAC ID: 2062632714 Enrollment ID: I20141001002121 |
| Provider Name | Gregory T Barry |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1568572634 PECOS PAC ID: 5395062137 Enrollment ID: I20150316001947 |
| Provider Name | Samir Hamed |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568166965 PECOS PAC ID: 8628427200 Enrollment ID: I20231207002072 |
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