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201 E Center St Ste 112 Anaheim CA 92805-7212 | |
| (832) 916-2677 | |
| (832) 802-6163 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 201 E Center St Ste 112, Anaheim, California |
| Authorized Official Name and Position | Fahd Rawra (OWNER) |
| Authorized Official Contact | 8329162677 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
110 S Gordon St Alvin TX 77511-2333 Ph: (832) 916-2677 | 201 E Center St Ste 112 Anaheim CA 92805-7212 Ph: (832) 916-2677 |
| NPI Number | 1336785187 |
|---|---|
| Provider Enumeration Date | 11/26/2019 |
| Last Update Date | 04/28/2023 |
| Certification Date | 04/28/2023 |
| Medicare PECOS PAC ID | 9638592082 |
|---|---|
| Medicare Enrollment ID | O20200702000624 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336785187 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Norberto Tuason |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1841338555 PECOS PAC ID: 5395649156 Enrollment ID: I20031122000150 |
| Provider Name | Michelle Stark |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972990067 PECOS PAC ID: 2365480001 Enrollment ID: I20050503001362 |
| Provider Name | Shalita Clark |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396214060 PECOS PAC ID: 1153662283 Enrollment ID: I20200124001776 |
| Provider Name | Fahd Rawra |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1245518786 PECOS PAC ID: 3072783828 Enrollment ID: I20200702000853 |
| Provider Name | Francis Mbella Manga |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154561439 PECOS PAC ID: 6204173479 Enrollment ID: I20210324000746 |
| Provider Name | Ernest Takang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467738963 PECOS PAC ID: 9537553417 Enrollment ID: I20220221000364 |
| Provider Name | Kelly Rae Axthelm |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1710303862 PECOS PAC ID: 9931545647 Enrollment ID: I20240315001364 |
| Provider Name | Omar Ahmad |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1558481333 PECOS PAC ID: 5193850592 Enrollment ID: I20240326003171 |
| Provider Name | Brianna Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710599386 PECOS PAC ID: 8527456045 Enrollment ID: I20240805000514 |
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