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17782 Cowan Ste D Irvine CA 92614-6088 | |
| (817) 680-5041 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 17782 Cowan Ste D, Irvine, California |
| Authorized Official Name and Position | Jada Alston (CO-OWNER) |
| Authorized Official Contact | 8176805041 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
17782 Cowan Ste A Irvine CA 92614-6041 Ph: () - | 17782 Cowan Ste D Irvine CA 92614-6088 Ph: (817) 680-5041 |
| NPI Number | 1558062265 |
|---|---|
| Provider Enumeration Date | 03/10/2023 |
| Last Update Date | 10/21/2024 |
| Certification Date | 10/21/2024 |
| Medicare PECOS PAC ID | 9133585045 |
|---|---|
| Medicare Enrollment ID | O20240709001185 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558062265 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
| Provider Name | Jason P Kellogg |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1952331530 PECOS PAC ID: 5597789123 Enrollment ID: I20060120000873 |
| Provider Name | Reginald Casilang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780784488 PECOS PAC ID: 6608923156 Enrollment ID: I20090420000659 |
| Provider Name | Linda H Trinh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124333828 PECOS PAC ID: 0547498834 Enrollment ID: I20140113001084 |
| Provider Name | Michael Frazier |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1225396591 PECOS PAC ID: 8224258132 Enrollment ID: I20140926002221 |
| Provider Name | Phuong Tran |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275990111 PECOS PAC ID: 4981900297 Enrollment ID: I20160314000930 |
| Provider Name | Jayson C Jun |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760808240 PECOS PAC ID: 1951607688 Enrollment ID: I20160929001727 |
| Provider Name | Dylan Thomas Guiney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295242410 PECOS PAC ID: 2567714983 Enrollment ID: I20181015000173 |
| Provider Name | Hong T Tran |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447723879 PECOS PAC ID: 9931447992 Enrollment ID: I20190218000209 |
| Provider Name | Maria D Acevedo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992363535 PECOS PAC ID: 2860724770 Enrollment ID: I20191025002338 |
| Provider Name | Jada Alston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427692375 PECOS PAC ID: 4082044532 Enrollment ID: I20200423001885 |
| Provider Name | Helen Oh Kim |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497380356 PECOS PAC ID: 5092136697 Enrollment ID: I20200608001928 |
| Provider Name | Agnes Andal Maramba |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770158172 PECOS PAC ID: 3870979081 Enrollment ID: I20220926001298 |
| Provider Name | Salina Vong Lum |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245710391 PECOS PAC ID: 8224414719 Enrollment ID: I20221006002454 |
| Provider Name | Kristi Lebesco |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386279172 PECOS PAC ID: 4880060961 Enrollment ID: I20221013003154 |
| Provider Name | Vanessa Michelle Yan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790458883 PECOS PAC ID: 9931575958 Enrollment ID: I20221017001687 |
| Provider Name | Angelo Jovito Caezar Santos Santiago |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356069900 PECOS PAC ID: 2163890914 Enrollment ID: I20221129000436 |
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