Healthcare Provider Details

I. General information

NPI: 1780310912
Provider Name (Legal Business Name): CHRISTINE NATELLI RICHARD PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2022
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30495 CANWOOD ST STE 101
AGOURA HILLS CA
91301-4331
US

IV. Provider business mailing address

PO BOX 2052
SIMI VALLEY CA
93062-2052
US

V. Phone/Fax

Practice location:
  • Phone: 818-707-7366
  • Fax: 818-306-5836
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95022050
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: