| Integrative Psychiatry A Medical Corporation | |
|
29982 Ivy Glenn Dr #203 Laguna Niguel CA 92677 | |
| (949) 309-7903 | |
| (949) 716-5243 |
| Full Name | Integrative Psychiatry A Medical Corporation |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 29982 Ivy Glenn Dr, Laguna Niguel, California |
| Authorized Official Name and Position | Grigor Grigoryan (CEO/PARTNER) |
| Authorized Official Contact | 9493097903 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Integrative Psychiatry A Medical Corporation 29982 Ivy Glenn Dr #203 Laguna Niguel CA 92677 Ph: (949) 309-7903 | Integrative Psychiatry A Medical Corporation 29982 Ivy Glenn Dr #203 Laguna Niguel CA 92677 Ph: (949) 309-7903 |
| NPI Number | 1720268980 |
|---|---|
| Provider Enumeration Date | 11/05/2007 |
| Last Update Date | 12/21/2021 |
| Certification Date | 12/21/2021 |
| Medicare PECOS PAC ID | 2961587159 |
|---|---|
| Medicare Enrollment ID | O20080312000371 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720268980 | NPI | - | NPPES |
| Provider Name | Vitaliy Shaulov |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1699705590 PECOS PAC ID: 4183650161 Enrollment ID: I20051109001061 |
| Provider Name | Jingyi Theis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659660058 PECOS PAC ID: 8628291077 Enrollment ID: I20140603002072 |
| Provider Name | Camay S Rooney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255820346 PECOS PAC ID: 6305194747 Enrollment ID: I20200221000660 |
| Provider Name | Grigor Grigoryan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205382231 PECOS PAC ID: 5496163248 Enrollment ID: I20210416001026 |
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