Provider Demographics
NPI:1922120963
Name:SOLOVJEV, GEORGE (PSYD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:SOLOVJEV
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 KALMUS DR
Mailing Address - Street 2:K-1
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-5988
Mailing Address - Country:US
Mailing Address - Phone:714-384-3870
Mailing Address - Fax:714-384-3875
Practice Address - Street 1:12665 GARDEN GROVE BLVD
Practice Address - Street 2:714
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1901
Practice Address - Country:US
Practice Address - Phone:714-620-8590
Practice Address - Fax:714-620-8595
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17567103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical