Provider Demographics
NPI:1770686347
Name:SOCAL PSYCHIATRIC MEDICAL GROUP, A MEDICAL CORPORATION
Entity type:Organization
Organization Name:SOCAL PSYCHIATRIC MEDICAL GROUP, A MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:L
Authorized Official - Last Name:ZUBRICK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:213-739-0019
Mailing Address - Street 1:3250 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 930
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-1438
Mailing Address - Country:US
Mailing Address - Phone:213-739-0019
Mailing Address - Fax:213-739-0091
Practice Address - Street 1:3250 WILSHIRE BLVD
Practice Address - Street 2:SUITE 930
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-1438
Practice Address - Country:US
Practice Address - Phone:213-739-0019
Practice Address - Fax:213-739-0091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty