Healthcare Provider Details

I. General information

NPI: 1669386231
Provider Name (Legal Business Name): ACT PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N BRAND BLVD STE 600
GLENDALE CA
91203-2349
US

IV. Provider business mailing address

450 N BRAND BLVD STE 600
GLENDALE CA
91203-2349
US

V. Phone/Fax

Practice location:
  • Phone: 818-476-4884
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JAMES HILL
Title or Position: PRACTICE OWNER
Credential:
Phone: 818-476-4884