Healthcare Provider Details

I. General information

NPI: 1093454423
Provider Name (Legal Business Name): OPEN MIND MENTAL HEALTH PHYSICIANS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2022
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3252 HOLIDAY CT STE 204
LA JOLLA CA
92037-1808
US

IV. Provider business mailing address

PO BOX 1429
SALISBURY NC
28145-1429
US

V. Phone/Fax

Practice location:
  • Phone: 855-550-6463
  • Fax: 833-343-2244
Mailing address:
  • Phone: 206-724-1722
  • Fax: 833-453-0569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: KERRY D KOZUKI
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 980-224-0959