MEDICARE: AD MELIORA ADVANCED PRACTICE NURSING CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1245067701
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AD MELIORA ADVANCED PRACTICE NURSING CORP

Provider Business Mailing Address
First Line	:	21550 OXNARD ST FL 3
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-7105
Country	:	US
Telephone Number	:	818-435-9555
Fax Number	:

Provider Business Practice Location Address
First Line	:	21550 OXNARD ST FL 3
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-7105
Country	:	US
Telephone Number	:	818-435-9555
Fax Number	:	747-888-5865

Authorized Official
Title or Position	:	CEO
Name	:	VICTOR COVARRUBIAS
Credential	:	PMHNP-BC
Telephone Number	:	818-435-9555

Provider Enumeration Date	:	09/18/2024
Last Update Date	:	10/10/2024

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Directions to “AD MELIORA ADVANCED PRACTICE NURSING CORP ” Practice Location

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