Healthcare Provider Details

I. General information

NPI: 1558293035
Provider Name (Legal Business Name): PHENOMENAL LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 OTTAWA AVE
CORCORAN CA
93212-9682
US

IV. Provider business mailing address

1362 W CORTNER ST
HANFORD CA
93230-8140
US

V. Phone/Fax

Practice location:
  • Phone: 559-380-4455
  • Fax:
Mailing address:
  • Phone: 559-380-4455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: NASTACIA DENNIS
Title or Position: CO-FOUNDER
Credential: RN
Phone: 559-309-3294