Healthcare Provider Details

I. General information

NPI: 1487582540
Provider Name (Legal Business Name): ORANGE PACIFIC MENTAL HEALTH, PROFESSIONAL NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N BRAND BLVD UNIT 200
GLENDALE CA
91203-3590
US

IV. Provider business mailing address

3935 NORMAL ST APT 309
SAN DIEGO CA
92103-3588
US

V. Phone/Fax

Practice location:
  • Phone: 503-987-3135
  • Fax: 503-388-7333
Mailing address:
  • Phone: 503-987-3135
  • Fax: 503-388-7333

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: TIMOTHY KORM
Title or Position: OWNER
Credential: PMHNP-BC
Phone: 978-328-3023