Provider Demographics
NPI:1346628179
Name:ORCHID HEALTHCARE INC
Entity Type:Organization
Organization Name:ORCHID HEALTHCARE INC
Other - Org Name:ORCHID HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SATYA
Authorized Official - Middle Name:V
Authorized Official - Last Name:TATA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-876-3105
Mailing Address - Street 1:15373 INNOVATION DRIVE, STE 395
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-3429
Mailing Address - Country:US
Mailing Address - Phone:858-876-3105
Mailing Address - Fax:858-876-3107
Practice Address - Street 1:15373 INNOVATION DRIVE, STE 395
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-3429
Practice Address - Country:US
Practice Address - Phone:858-876-3105
Practice Address - Fax:858-876-3107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25897103TC2200X
CALMFT84598106H00000X
CAA982732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty