Provider Demographics
NPI:1457793671
Name:SOUTH COAST PSYCHIATRIC ADVANCED NURSING PRACTICE
Entity type:Organization
Organization Name:SOUTH COAST PSYCHIATRIC ADVANCED NURSING PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GEORGETA
Authorized Official - Middle Name:LAURA
Authorized Official - Last Name:DRANCEA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:714-484-4900
Mailing Address - Street 1:3400 W BALL RD
Mailing Address - Street 2:SUITE 100B
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-3738
Mailing Address - Country:US
Mailing Address - Phone:714-484-4900
Mailing Address - Fax:714-484-4903
Practice Address - Street 1:3400 W BALL RD
Practice Address - Street 2:SUITE 100B
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3738
Practice Address - Country:US
Practice Address - Phone:714-484-4900
Practice Address - Fax:714-484-4903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16553163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP16553Medicare UPIN