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601 Parkcenter Dr Suite 206 Santa Ana CA 92705-3522 | |
| (714) 453-0688 | |
| (714) 453-0691 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 601 Parkcenter Dr, Santa Ana, California |
| Authorized Official Name and Position | Geoffrey B. Phillips (PRESIDENT) |
| Authorized Official Contact | 7144530688 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
601 Parkcenter Dr Suite 206 Santa Ana CA 92705-3522 Ph: (714) 453-0688 | 601 Parkcenter Dr Suite 206 Santa Ana CA 92705-3522 Ph: (714) 453-0688 |
| NPI Number | 1528068707 |
|---|---|
| Provider Enumeration Date | 07/28/2005 |
| Last Update Date | 08/17/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528068707 | NPI | - | NPPES |
| LICENSE # 2780787 | Other | CA | STATE LICENSE # |
| ZZZ65665Z | Other | CA | BLUE SHIELD OF CA |
| GR0100750 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 2780787 (California) | Primary |
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