Healthcare Provider Details

I. General information

NPI: 1184546459
Provider Name (Legal Business Name): MIND GRIT ADVANCED PSYCHIATRIC NURSING, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18000 STUDEBAKER RD STE 700
CERRITOS CA
90703-2684
US

IV. Provider business mailing address

18000 STUDEBAKER RD STE 700
CERRITOS CA
90703-2684
US

V. Phone/Fax

Practice location:
  • Phone: 562-231-6529
  • Fax:
Mailing address:
  • Phone: 562-231-6529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: AMY LA
Title or Position: SECRETARY
Credential: PHD
Phone: 562-231-6529