Healthcare Provider Details

I. General information

NPI: 1932972247
Provider Name (Legal Business Name): PRO HEALTH PSYCHIATRY NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PARK PLZ STE 600
IRVINE CA
92614-5987
US

IV. Provider business mailing address

4533 MACARTHUR BLVD STE A-2068
NEWPORT BEACH CA
92660-2059
US

V. Phone/Fax

Practice location:
  • Phone: 949-828-1546
  • Fax:
Mailing address:
  • Phone: 562-833-0518
  • Fax:

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: JACOB OLSEN
Title or Position: CEO
Credential: PMHNP
Phone: 562-833-0518