NPIMap

Organization Active NPI

Integrative Psychiatry a Medical Corporation

  • Psychiatry Physician
  • Laguna Niguel, CA
National Provider Identifier
1720268980
Registry record updated Dec 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
INTEGRATIVE PSYCHIATRY A MEDICAL CORPORATION
Practice address
29982 Ivy Glenn Dr
#203
Laguna Niguel, CA 92677
Phone
(949) 309-7903
Fax
(949) 716-5243
NPI assigned
Nov 5, 2007
Last updated
Dec 21, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2021

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

Authorized official

Name
Grigor Grigoryan, DNPNPI 1205382231
Title
Ceo/Partner
Phone
(949) 309-7903

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X A775921 CA
Marriage & Family Therapist 106H00000X
Psychiatry Physician 2084P0800X Primary

Addresses

Primary practice location

29982 Ivy Glenn Dr
#203
Laguna Niguel, CA 92677

Mailing address

29982 Ivy Glenn Dr
#203
Laguna Niguel, CA 92677
Phone (949) 309-7903

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080312000371 CA Part B Supplier - Clinic/Group Practice 2961587159 Receives reassigned benefits from 4 practitioners
Practice locations: Laguna Niguel, CA
O20220201001918 CA Part B Supplier - Clinic/Group Practice 4587057286 Receives reassigned benefits from 9 practitioners
Practice locations: Laguna Niguel, CA

National Provider Directory

National Provider Directory

Locations

29982 Ivy Glenn Dr
Ste 203
Laguna Niguel, CA 92677
Phone (949) 309-7903

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1194220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640044800000",
    "number": "1720268980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29982 IVY GLENN DR",
            "address_2": "#203",
            "city": "LAGUNA NIGUEL",
            "state": "CA",
            "postal_code": "92677",
            "telephone_number": "949-309-7903",
            "fax_number": "949-716-5243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29982 IVY GLENN DR",
            "address_2": "#203",
            "city": "LAGUNA NIGUEL",
            "state": "CA",
            "postal_code": "92677",
            "telephone_number": "949-309-7903",
            "fax_number": "949-716-5243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATIVE PSYCHIATRY A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-05",
        "last_updated": "2021-12-21",
        "certification_date": "2021-12-21",
        "status": "A",
        "authorized_official_last_name": "GRIGORYAN",
        "authorized_official_first_name": "GRIGOR",
        "authorized_official_title_or_position": "CEO/PARTNER",
        "authorized_official_telephone_number": "949-309-7903",
        "authorized_official_credential": "DNP"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "A775921",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Laguna Niguel, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.