Provider Demographics
NPI:1780730689
Name:INTERIM PSYCHIATRIC CARE, MEDICAL CORPORATION
Entity type:Organization
Organization Name:INTERIM PSYCHIATRIC CARE, MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BHUPINDER
Authorized Official - Middle Name:S
Authorized Official - Last Name:NAKAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-945-3330
Mailing Address - Street 1:9327 FAIRWAY VIEW PL
Mailing Address - Street 2:STE 110
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-0968
Mailing Address - Country:US
Mailing Address - Phone:909-945-3330
Mailing Address - Fax:909-945-1031
Practice Address - Street 1:9327 FAIRWAY VIEW PL
Practice Address - Street 2:STE 110
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0968
Practice Address - Country:US
Practice Address - Phone:909-945-3330
Practice Address - Fax:909-945-1031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT32483106H00000X
CAMFC34041106H00000X
CAMFC32911106H00000X
CAA534670174400000X
CAC50549174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS25407OtherCA BOARD OF SOCIAL WORKERS
CA00A534672Medicaid
CAPSY21662OtherCA BOARD OF PSYCHOLOGY
CA00C505490Medicaid
CA00A534672Medicare ID - Type UnspecifiedDR. SAEED
CA00C505490Medicaid
CAPSY21662OtherCA BOARD OF PSYCHOLOGY
CA00A534672Medicare UPIN