Healthcare Provider Details

I. General information

NPI: 1265201222
Provider Name (Legal Business Name): MARIA DELIA FORTUNATO PMHNP BC A PROFESSIONAL NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/01/2024
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 S GRAND AVE STE 2450
LOS ANGELES CA
90071-9500
US

IV. Provider business mailing address

2041 EAST ST UNIT 805
CONCORD CA
94520-2126
US

V. Phone/Fax

Practice location:
  • Phone: 213-377-0012
  • Fax: 213-377-0044
Mailing address:
  • Phone: 213-377-0012
  • Fax: 213-377-0044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARIA DELIA DEJARME FORTUNATO
Title or Position: PROVIDER
Credential: PMHNP-BC
Phone: 213-377-0012