Basic Information
| Provider Information | |||||||||
| NPI: | 1467551200 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUNNYHILLS BEHAVIORAL HEALTH INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 140 E. COMMONWEALTH AVE. | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928323616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147734111 | ||||||||
| FaxNumber: | 7147734222 | ||||||||
| Practice Location | |||||||||
| Address1: | 140 E. COMMONWEALTH AVE. | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928323616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147734111 | ||||||||
| FaxNumber: | 7147734222 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 12/15/2016 | ||||||||
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| AuthorizedOfficialLastName: | GUDAPATI | ||||||||
| AuthorizedOfficialFirstName: | SANDHYA | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7147734111 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | A46239 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 00A462391 | 05 | CA | MEDICAID |