Healthcare Provider Details

I. General information

NPI: 1306751755
Provider Name (Legal Business Name): NORTH STAR PSYCHIATRY, A PROFESSIONAL NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18885 DEODAR ST
FOUNTAIN VALLEY CA
92708-7222
US

IV. Provider business mailing address

2618 SAN MIGUEL DR # 2151
NEWPORT BEACH CA
92660-5437
US

V. Phone/Fax

Practice location:
  • Phone: 949-996-8342
  • Fax:
Mailing address:
  • Phone: 949-996-8342
  • Fax: 949-996-8038

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: J PAUL GATDULA
Title or Position: PSYCHIATRIC NP / FOUNDER
Credential: PMHNP-BC
Phone: 949-996-8342