NPIMap

Organization Active NPI

Pacific Neurobehavioral Clinic: a Psychological Corporation

  • Community/Behavioral Health Agency
  • San Diego, CA
National Provider Identifier
1952724817
Registry record updated May 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
PSY22738 Issued in CA
Legal business name
PACIFIC NEUROBEHAVIORAL CLINIC: A PSYCHOLOGICAL CORPORATION
Practice address
3990 Old Town Ave Ste C303
San Diego, CA 92110-2932
Phone
(858) 964-0722
Fax
(866) 437-0375
NPI assigned
Jan 29, 2014
Last updated
May 26, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 26, 2026

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

Authorized official

Name
Alexis Olson Bachiega, PHDNPI 1912315037
Title
Ceo
Phone
(858) 964-0722

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Clinical Neuropsychologist 103G00000X
Psychologist 103T00000X
Community/Behavioral Health Agency 251S00000X PSY22738 CA Primary

Addresses

Primary practice location

3990 Old Town Ave Ste C303
San Diego, CA 92110-2932

Mailing address

3990 Old Town Ave Ste C303
San Diego, CA 92110-2932
Phone (858) 964-0722

Other names 1

  • Pacific Neurobehavioral Clinic, PC Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150210002211 CA Part B Supplier - Clinic/Group Practice 9234454422 Receives reassigned benefits from 10 practitioners
Practice locations: San Diego, CA

National Provider Directory

National Provider Directory

Locations

1901 1st Ave
Ste 245
San Diego, CA 92101
Phone (619) 232-2225

3636 4th Ave
Ste 310
San Diego, CA 92103
Phone (858) 964-0722

3990 Old Town Ave
Ste C303
San Diego, CA 92110
Phone (858) 964-0722

4080 Centre St
Ste 104
San Diego, CA 92103
Phone (619) 543-9850

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1390953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779753600000",
    "number": "1952724817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3990 OLD TOWN AVE STE C303",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921102932",
            "telephone_number": "858-964-0722",
            "fax_number": "866-437-0375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3990 OLD TOWN AVE STE C303",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921102932",
            "telephone_number": "858-964-0722",
            "fax_number": "866-437-0375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC NEUROBEHAVIORAL CLINIC: A PSYCHOLOGICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-29",
        "last_updated": "2026-05-26",
        "certification_date": "2026-05-26",
        "status": "A",
        "authorized_official_last_name": "OLSON BACHIEGA",
        "authorized_official_first_name": "ALEXIS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "858-964-0722",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "CA",
            "license": "PSY22738",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pacific Neurobehavioral Clinic, PC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2026; 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.