Provider Demographics
NPI:1093284739
Name:SOCAL SUNNY HILLS, LLC
Entity Type:Organization
Organization Name:SOCAL SUNNY HILLS, LLC
Other - Org Name:SOCAL SUNNY HILLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:PANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-RN
Authorized Official - Phone:714-887-3816
Mailing Address - Street 1:1057 E IMPERIAL HWY APT 226
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-1717
Mailing Address - Country:US
Mailing Address - Phone:714-887-3816
Mailing Address - Fax:
Practice Address - Street 1:1296 CORONET DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-5639
Practice Address - Country:US
Practice Address - Phone:714-887-3816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-23
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty