SAN DIEGO PROFESSIONAL GROUP P. C. NPI 1699220004

NPI Information

NPI: 1699220004
Provider Name: SAN DIEGO PROFESSIONAL GROUP, P. C.
Classification: Psychiatry & Neurology - 2084A0401X
Entity Type: Organization

Specialization: Addiction Medicine

Address:
24552 PACIFIC PARK DR
ALISO VIEJO, CA
ZIP 92656
Phone: (615) 727-8416
Get Directions

SAN DIEGO PROFESSIONAL GROUP, P. C. is an addiction medicine psychiatry neurology in Aliso Viejo, CA. The provider is a doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine SAN DIEGO PROFESSIONAL GROUP, P. C. NPI is 1699220004. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

24552 PACIFIC PARK DR
ALISO VIEJO, CA
ZIP 92656-033
Phone: (615) 727-8416
Fax: (615) 457-8094

The provider's authorized official is Mark Calarco .
The authorized official title is Facility Ceo and has the following contact phone number (615) 712-5862.

The enumeration date for this NPI number is 8/16/2016 and was last updated on 8/25/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	103TA0400X	Psychologist	Addiction (Substance Use Disorder)	20A6119	CALIFORNIA	No
2	207RA0401X	Internal Medicine	Addiction Medicine	20A6119	CALIFORNIA	No
3	2084A0401X	Psychiatry & Neurology	Addiction Medicine	20A6119	CALIFORNIA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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