Healthcare Provider Details

I. General information

NPI: 1649103904
Provider Name (Legal Business Name): INTEGRATED MINDBODY MEDICAL AND MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17777 CENTER COURT DR N
CERRITOS CA
90703-9320
US

IV. Provider business mailing address

PO BOX 92051
LONG BEACH CA
90809-2051
US

V. Phone/Fax

Practice location:
  • Phone: 409-356-9779
  • Fax: 409-356-9779
Mailing address:
  • Phone: 409-356-9779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PERPETUA OKOH
Title or Position: CEO
Credential: NP
Phone: 409-356-9779