NPIMap

Organization Active NPI

Integrated Recovery Foundation 22

  • Behavioral Neurology & Neuropsychiatry Physician
  • Rancho Santa Margarita, CA
National Provider Identifier
1568024263
Registry record updated Jun 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavioral Neurology & Neuropsychiatry PhysicianTaxonomy code 2084B0040X
Legal business name
INTEGRATED RECOVERY FOUNDATION 22
Practice address
30211 Avenida de Las Bandera Ste 200
Rancho Santa Margarita, CA 92688-2159
Phone
(949) 533-6075
Fax
(949) 484-7021
NPI assigned
Jul 2, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2020

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

Authorized official

Name
Myrna B Fernandez, LPTNPI 1245742113
Title
Ur/Billing
Phone
(951) 813-1720

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Cognitive & Behavioral PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TB0200X
Behavioral Neurology & Neuropsychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084B0040X Primary
Community/Behavioral Health Agency 251S00000X
Adult Mental Health Clinic/Center 261QM0850X
Multi-Specialty Clinic/Center 261QM1300X
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X

Addresses

Primary practice location

30211 Avenida de Las Bandera Ste 200
Rancho Santa Margarita, CA 92688-2159

Mailing address

25 Flor Amor
Rancho Santa Margarita, CA 92688
Phone (951) 813-1720

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1562025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591660800000",
    "number": "1568024263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 FLOR AMOR",
            "city": "RANCHO SANTA MARGARITA",
            "state": "CA",
            "postal_code": "92688",
            "telephone_number": "951-813-1720",
            "fax_number": "949-484-7021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30211 AVENIDA DE LAS BANDERA STE 200",
            "city": "RANCHO SANTA MARGARITA",
            "state": "CA",
            "postal_code": "926882159",
            "telephone_number": "949-533-6075",
            "fax_number": "949-484-7021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED RECOVERY FOUNDATION 22",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-02",
        "last_updated": "2020-06-09",
        "certification_date": "2020-06-09",
        "status": "A",
        "authorized_official_last_name": "FERNANDEZ",
        "authorized_official_first_name": "MYRNA",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "UR/BILLING",
        "authorized_official_telephone_number": "951-813-1720",
        "authorized_official_credential": "LPT"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084B0040X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rancho Santa Margarita, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2020; 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.