Provider Demographics
NPI:1821880212
Name:INNERSPACE PSYCHIATRY PC
Entity type:Organization
Organization Name:INNERSPACE PSYCHIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLEAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-541-2323
Mailing Address - Street 1:55 SANTA CLARA AVE STE 171
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-1333
Mailing Address - Country:US
Mailing Address - Phone:510-541-2323
Mailing Address - Fax:510-907-7966
Practice Address - Street 1:55 SANTA CLARA AVE STE 171
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-1333
Practice Address - Country:US
Practice Address - Phone:510-541-2323
Practice Address - Fax:510-907-7966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty