Provider Demographics
NPI:1831159003
Name:THE DEPARTMENT OF PSYCHIATRY
Entity type:Organization
Organization Name:THE DEPARTMENT OF PSYCHIATRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:US PROVIDER RELATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:UCI HEALTH
Authorized Official - Middle Name:
Authorized Official - Last Name:PROVIDER RELATIONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-456-2986
Mailing Address - Street 1:PO BOX 31001-2473
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91110-2473
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 THE CITY DR S
Practice Address - Street 2:BLDG 3
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:949-824-1283
Practice Address - Fax:949-824-9891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZP3015ZMedicaid
CAZZZP3015ZMedicaid