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4060 Campus Dr Ste 120 Newport Beach CA 92660-2205 | |
| (949) 475-0145 | |
| (949) 475-2977 |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 4060 Campus Dr Ste 120, Newport Beach, California |
| Authorized Official Name and Position | Teri M. Pokrajac (OWNER) |
| Authorized Official Contact | 9494750145 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
4060 Campus Dr Ste 120 Newport Beach CA 92660-2205 Ph: (949) 475-0145 | 4060 Campus Dr Ste 120 Newport Beach CA 92660-2205 Ph: (949) 475-0145 |
| NPI Number | 1720352214 |
|---|---|
| Provider Enumeration Date | 02/29/2012 |
| Last Update Date | 02/29/2012 |
| Medicare PECOS PAC ID | 8628238706 |
|---|---|
| Medicare Enrollment ID | O20120327000812 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720352214 | NPI | - | NPPES |
| CP15458 | Other | CA | MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | PSY15458 (California) | Primary |
| Provider Name | Teri M Pokrajac |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1891900940 PECOS PAC ID: 5597925677 Enrollment ID: I20120327000870 |
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