Positive Recovery Center

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY6949 Issued in CA

Legal business name

POSITIVE RECOVERY CENTER

Practice address

17291 Irvine Blvd Ste 104
Tustin, CA 92780-2929

Phone

(714) 730-0505

Fax

(714) 730-0113

NPI assigned

Dec 7, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Miss Ana M Cordova

Title

Manager

Phone

(714) 730-0505

Specialties & licenses 3

Addresses

Other identifiers 3

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Robert McDaniel, MD

  • Mental Health Counselor
  • Tustin, CA
  • NPI 1245595495
  NPD (past)
• Ismail Yassai, PH.D.

  • Psychologist
  • Tustin, CA
  • NPI 1548351489
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1323216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323216000000",
    "number": "1467720243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17291 IRVINE BLVD STE 104",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927802929",
            "telephone_number": "714-730-0505",
            "fax_number": "714-730-0113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17291 IRVINE BLVD STE 104",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927802929",
            "telephone_number": "714-730-0505",
            "fax_number": "714-730-0113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POSITIVE RECOVERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-07",
        "last_updated": "2011-12-07",
        "status": "A",
        "authorized_official_last_name": "CORDOVA",
        "authorized_official_first_name": "ANA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "714-730-0505",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY6949",
            "primary": true
        },
        {
            "code": "103TH0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Health Service",
            "state": "CA",
            "license": "PSY6949",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "PSY6949",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD PPO",
            "identifier": "PSY6949",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIVATE",
            "identifier": "PSY6949",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WORKERS COMPENSATION",
            "identifier": "PSY6949",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Raymond Poon
• Laurie Ann Poore, PHD
• Arturo Portales, D.O.
• Benjamin Steven Portillo
• Portview Preparatory, Inc.
• Post Speech Pathology, Inc.
• Manuela O Powers, BCBA
• Prairie Dialysis LLC
• Preferred Care Services, LLC
• Premier Dental

• Psychologist in Tustin, CA
• Providers in Tustin, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.