Provider Demographics
NPI:1154134930
Name:OCEAN PACIFIC PSYCHOLOGY
Entity type:Organization
Organization Name:OCEAN PACIFIC PSYCHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:323-831-9955
Mailing Address - Street 1:414 W GRAND BLVD UNIT 2141
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92878-7298
Mailing Address - Country:US
Mailing Address - Phone:323-831-9955
Mailing Address - Fax:
Practice Address - Street 1:10832 LAUREL ST STE 102
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-7688
Practice Address - Country:US
Practice Address - Phone:323-831-9955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty