MEDICARE: CLEARMIND CLINIC, INC.

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	:	1639026594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEARMIND CLINIC, INC.

Provider Business Mailing Address
First Line	:	PO BOX 226
Second Line	:
City	:	ETIWANDA
State	:	CA
Zip	:	91739-0226
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 N WATERMAN AVE
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92404-5115
Country	:	US
Telephone Number	:	510-329-0837
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	RAMANPAL PUNIA
Credential	:	PMHNP
Telephone Number	:	510-303-0817

Provider Enumeration Date	:	03/11/2026
Last Update Date	:	03/11/2026

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