SOUTHERN CALIFORNIA PSYCHOLOGICAL (NPI# 1053745497) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053745497 |
| Entity Type | Organization |
| Organization Name | SOUTHERN CALIFORNIA PSYCHOLOGICAL |
| Practice Address |
17821 17th St Ste 250 Tustin CA 92780-2173 |
| Practice Telephone | 7145052093 |
| Practice Fax Number | 7145730072 |
| Mailing Telephone | 7145052093 |
| Mailing Fax Number | 7145730072 |
| Enumeration Date | 2013-08-21 |
| Last Update Date | 2013-08-21 |
| Authorized Official Name | DR. KIMBERELY TILLEY (PRESIDENT) |
| Authorized Official Telephone | 7145052093 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | PSY23488 | CA | Other Service Providers |
| Street Address |
17821 17TH ST STE 250 |
| City | TUSTIN |
| State | CA |
| Zip Code | 92780-2173 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205380532 | Exam Specialist Medical Group | Specialist | 17821 17th St Ste 250, Tustin, CA 92780-2173 | 2016-08-03 |
| 1063846442 | Fig Garden Medical Group | Specialist | 17821 17th St Ste 250, Tustin, CA 92780-2173 | 2013-08-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437780947 | John Michael Michael | Pharmacist | 14481 Wildeve Ln, Tustin, CA 92780 | 2020-02-03 |
| 1609426881 | Abigail Joy Maqsood | Behavior Technician | 290a S Prospect Ave, Tustin, CA 92780 | 2019-09-19 |
| 1255814711 | Hyun Dong Lee | Chiropractor | 14591 Newport Ave Ste 106, Tustin, CA 92780 | 2018-09-11 |
| 1346733573 | Elizabeth Kim Nguyen Dds Inc | Clinic/Center | 14521 Red Hill Ave, Tustin, CA 92780 | 2018-06-12 |
| 1255829503 | Hw Physical Therapy | Physical Therapist | 250 El Camino Real Ste 100, Tustin, CA 92780 | 2018-04-23 |
| 1912494352 | Gary Wayne Mcbeath | Marriage & Family Therapist | 17821 E 17th Street, Suite # 260, Tustin, CA 92780 | 2018-04-20 |
| 1104334598 | Catherine Bogues | Speech-Language Pathologist | 661 West 1st Street, Suite E, Tustin, CA 92780 | 2018-01-19 |
| 1972019941 | Lighthouse Behavioral Solutions | Behavioral Analyst | 18002 Irvine Blvd., Suite 202c, Tustin, CA 92780 | 2017-12-28 |
| 1629597299 | Lifecab, LLC | Non-emergency Medical Transport (VAN) | 13732 Newport Ave, Suite #1, Tustin, CA 92780 | 2017-09-14 |
| 1437606555 | Tustin Speech Therapy, Inc. | Speech-Language Pathologist | 661 West First Street, Suite E, Tustin, CA 92780 | 2016-09-07 |
| Find all providers in zip 92780 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093173221 | Jolina Lyn Manchester | Specialist | 2800 Keller Dr, Apt. 234, Tustin, CA 92782-1065 | 2016-02-02 |
| 1689093312 | Pia Rotman | Specialist | 155 El Camino Real, Tustin, CA 92780-3601 | 2014-04-09 |
| 1184825028 | Samireh Z. Said, M.d., Inc. | Specialist | 13422 Newport Ave Ste J, Tustin, CA 92780-3746 | 2007-05-29 |
| 1841386349 | Roger Kornu | Specialist | 12791 Newport Ave Ste 208, Tustin, CA 92780 | 2006-10-04 |
| 1841397700 | Rose Marie Angella Pitt | Specialist | 14181 Yorba St Ste 110, Tustin, CA 92780-2054 | 2006-09-20 |
| 1447283437 | My Way Management Services, LLC | Specialist | 2913 El Camino Real # 344, Tustin, CA 92782-8909 | 2006-07-10 |
| 1336129998 | Samireh Z Said | Specialist | 13422 Newport Avenue, Suite J, Tustin, CA 92780 | 2006-01-19 |
| 1780689042 | Charles Kyumin Oh | Specialist | 2552 Walnut Ave, Suite 130, Tustin, CA 92780-6935 | 2005-06-14 |
| 1518960418 | Ramon E Perez | Specialist | 17602 17th St, # 102-154, Tustin, CA 92780-1961 | 2005-05-24 |
| 1205380532 | Exam Specialist Medical Group | Specialist | 17821 17th St Ste 250, Tustin, CA 92780-2173 | 2016-08-03 |
| Find all providers in TUSTIN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.