Healthcare Provider Details

I. General information

NPI: 1558905158
Provider Name (Legal Business Name): SASINEE J BHOSAI NP PSYCHIATRIC NURSING CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2019
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 W ROUTE 66 STE 202
GLENDORA CA
91740-4335
US

IV. Provider business mailing address

415 W ROUTE 66 STE 202
GLENDORA CA
91740-4335
US

V. Phone/Fax

Practice location:
  • Phone: 626-963-4467
  • Fax: 626-963-9543
Mailing address:
  • Phone: 626-963-4467
  • Fax: 626-963-9543

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: SASINEE JADE BHOSAI
Title or Position: OWNER
Credential: PMHNP-BC
Phone: 626-963-4467