Healthcare Provider Details

I. General information

NPI: 1003773318
Provider Name (Legal Business Name): J PATRICK NESSIA GATDULA PMHNP-BC, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 MAIN ST UNIT 462
IRVINE CA
92614-5277
US

IV. Provider business mailing address

2700 MAIN ST UNIT 462
IRVINE CA
92614-5277
US

V. Phone/Fax

Practice location:
  • Phone: 562-673-6776
  • Fax:
Mailing address:
  • Phone: 562-673-6776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95037628
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: