Provider Demographics
NPI:1457567257
Name:NEUROBEHAVIORAL HEALTH CARE MED GRP INC
Entity Type:Organization
Organization Name:NEUROBEHAVIORAL HEALTH CARE MED GRP INC
Other - Org Name:PEDIATRIC CRITICAL CARE MED GRP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:DOBRIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-707-4757
Mailing Address - Street 1:32446 CROWN VALLEY PARKWAY
Mailing Address - Street 2:#204
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3342
Mailing Address - Country:US
Mailing Address - Phone:949-707-4757
Mailing Address - Fax:949-488-7840
Practice Address - Street 1:33971 SELVA RD
Practice Address - Street 2:SUITE 120
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-3342
Practice Address - Country:US
Practice Address - Phone:949-707-4757
Practice Address - Fax:949-488-7840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG 19275208000000X, 2084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty