MEDICARE: SUNVALLEY PSYCH, A NURSING CORPORATION

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1619893427
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNVALLEY PSYCH, A NURSING CORPORATION

Provider Business Mailing Address
First Line	:	550 E CARSON PLAZA DR STE 208
Second Line	:
City	:	CARSON
State	:	CA
Zip	:	90746-7369
Country	:	US
Telephone Number	:	206-456-6933
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 E CARSON PLAZA DR STE 208
Second Line	:
City	:	CARSON
State	:	CA
Zip	:	90746-7369
Country	:	US
Telephone Number	:	206-456-6933
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JUDITH ANUGOM
Credential	:
Telephone Number	:	206-456-6933

Provider Enumeration Date	:	06/25/2026
Last Update Date	:	06/25/2026

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