Basic Information
| Provider Information | |||||||||
| NPI: | 1063044410 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PACIFIC COAST PSYCHIATRIC ASSOCIATES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 490 POST ST STE 1043 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941021301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9252314325 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4550 KEARNY VILLA RD STE 116 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921231583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8582791223 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2020 | ||||||||
| LastUpdateDate: | 02/10/2020 | ||||||||
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| AuthorizedOfficialLastName: | PATEL-DUNN | ||||||||
| AuthorizedOfficialFirstName: | ANISHA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4154090944 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0850X | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | 261QM0855X | N | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.