Healthcare Provider Details

I. General information

NPI: 1144795261
Provider Name (Legal Business Name): DIVINE BLISS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2018
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 PARNELL PL
COSTA MESA CA
92626-2737
US

IV. Provider business mailing address

1219 PARNELL PL
COSTA MESA CA
92626-2737
US

V. Phone/Fax

Practice location:
  • Phone: 714-581-3974
  • Fax:
Mailing address:
  • Phone: 954-496-2885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. SERENA GUPTA
Title or Position: PRESIDENT
Credential: PH.D., LMFT
Phone: 714-606-4012