Provider Demographics
NPI:1417768722
Name:ALTERNATIVE AWAKENINGS PSYCHIATRY, A PROFESSIONAL NURSING CORPORATION
Entity type:Organization
Organization Name:ALTERNATIVE AWAKENINGS PSYCHIATRY, A PROFESSIONAL NURSING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JULIE ANN THERESE
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LOS SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:530-691-0194
Mailing Address - Street 1:8620 BELFORD AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:90045-4746
Mailing Address - Country:US
Mailing Address - Phone:530-691-0194
Mailing Address - Fax:310-691-0194
Practice Address - Street 1:1849 SAWTELLE BLVD STE 610
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7013
Practice Address - Country:US
Practice Address - Phone:530-691-0194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty