Provider Demographics
NPI:1306220199
Name:SOUTHERN CALIFORNIA PSYCHIATRIC ASSOCIATES
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA PSYCHIATRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-489-5564
Mailing Address - Street 1:14351 RED HILL AVE STE C
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-6271
Mailing Address - Country:US
Mailing Address - Phone:949-489-5564
Mailing Address - Fax:949-493-9350
Practice Address - Street 1:14351 RED HILL AVE STE C
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6271
Practice Address - Country:US
Practice Address - Phone:949-489-5564
Practice Address - Fax:949-493-9350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27276103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty