Provider Demographics
NPI:1952724817
Name:PACIFIC NEUROBEHAVIORAL CLINIC, INC.
Entity Type:Organization
Organization Name:PACIFIC NEUROBEHAVIORAL CLINIC, INC.
Other - Org Name:PACIFIC NEUROBEHAVIORAL CLINIC, PC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:858-964-0722
Mailing Address - Street 1:4080 CENTRE ST STE 104
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2655
Mailing Address - Country:US
Mailing Address - Phone:858-964-0722
Mailing Address - Fax:
Practice Address - Street 1:3636 4TH AVE STE 310
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4294
Practice Address - Country:US
Practice Address - Phone:858-964-0722
Practice Address - Fax:866-437-0375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-29
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X, 261QM0801X
CAPSY22738251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)