Healthcare Provider Details

I. General information

NPI: 1033803176
Provider Name (Legal Business Name): MINA CHERIKI RN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 W BALL RD STE 4C
ANAHEIM CA
92804-5591
US

IV. Provider business mailing address

1720 W BALL RD STE 4C
ANAHEIM CA
92804-5591
US

V. Phone/Fax

Practice location:
  • Phone: 714-683-1472
  • Fax:
Mailing address:
  • Phone: 714-683-1472
  • Fax: 714-683-1473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95250143
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95034676
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: