Healthcare Provider Details

I. General information

NPI: 1821961020
Provider Name (Legal Business Name): MINDSCAPE JOURNEYS NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2025
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 PACIFIC COAST HWY STE 103
HERMOSA BEACH CA
90254-2700
US

IV. Provider business mailing address

2200 PACIFIC COAST HWY STE 103
HERMOSA BEACH CA
90254-2700
US

V. Phone/Fax

Practice location:
  • Phone: 424-728-5564
  • Fax: 424-377-6548
Mailing address:
  • Phone: 424-484-8357
  • Fax: 424-377-6548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DYANA KO
Title or Position: PRESIDENT
Credential: NP
Phone: 424-484-8357