Healthcare Provider Details

I. General information

NPI: 1508677121
Provider Name (Legal Business Name): OVERHEAD SUN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2025
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4521 E CESAR E CHAVEZ AVE
LOS ANGELES CA
90022-1116
US

IV. Provider business mailing address

2436 E 4TH ST # 532
LONG BEACH CA
90814-1156
US

V. Phone/Fax

Practice location:
  • Phone: 562-533-7373
  • Fax:
Mailing address:
  • Phone: 562-533-7373
  • Fax: 209-364-1373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: HILLARY MENNELLA
Title or Position: OWNER
Credential: PMHNP
Phone: 562-533-7373