Provider Demographics
NPI:1467329631
Name:PHOTIC MOOD & ANXIETY CARE LLC
Entity type:Organization
Organization Name:PHOTIC MOOD & ANXIETY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NABI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-287-9630
Mailing Address - Street 1:11120 E OCEAN AIR DR STE B-101170
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-4683
Mailing Address - Country:US
Mailing Address - Phone:562-287-9630
Mailing Address - Fax:
Practice Address - Street 1:4668 CORTE MAR DEL CORAZON
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2692
Practice Address - Country:US
Practice Address - Phone:562-287-9630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-21
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty