Provider Demographics
NPI:1386066363
Name:SOUTHERN CALIFORNIA PSYCHOLOGY CENTERS, APC
Entity type:Organization
Organization Name:SOUTHERN CALIFORNIA PSYCHOLOGY CENTERS, APC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SAURABH
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:619-537-9345
Mailing Address - Street 1:8775 AERO DR STE 238
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1756
Mailing Address - Country:US
Mailing Address - Phone:619-930-9524
Mailing Address - Fax:619-269-9245
Practice Address - Street 1:8775 AERO DR
Practice Address - Street 2:SUITE 238
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1792
Practice Address - Country:US
Practice Address - Phone:855-629-7272
Practice Address - Fax:619-269-9245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-10
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 24218261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)