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12555 Garden Grove Blvd Ste 401 Garden Grove CA 92843-1903 | |
| (909) 609-5737 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 12555 Garden Grove Blvd Ste 401, Garden Grove, California |
| Authorized Official Name and Position | Michel Darazi (PRESIDENT) |
| Authorized Official Contact | 5084888227 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
12555 Garden Grove Blvd, Unit 401 Garden Grove CA 92843 Ph: (909) 609-5737 | 12555 Garden Grove Blvd Ste 401 Garden Grove CA 92843-1903 Ph: (909) 609-5737 |
| NPI Number | 1841049038 |
|---|---|
| Provider Enumeration Date | 05/18/2024 |
| Last Update Date | 06/14/2024 |
| Certification Date | 06/14/2024 |
| Medicare PECOS PAC ID | 8325587843 |
|---|---|
| Medicare Enrollment ID | O20240828003949 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841049038 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | David D Nacionales |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1699169227 PECOS PAC ID: 5294068078 Enrollment ID: I20200918001080 |
| Provider Name | Michel Darazi |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1003286550 PECOS PAC ID: 4082045240 Enrollment ID: I20210811002393 |
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