Healthcare Provider Details

I. General information

NPI: 1700683430
Provider Name (Legal Business Name): INTEGRATIVE PSYCHIATRY & WELLNESS PROFESSIONAL NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2025
Last Update Date: 10/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27201 PUERTA REAL STE 300
MISSION VIEJO CA
92691
US

IV. Provider business mailing address

23986 ALISO CREEK RD
LAGUNA NIGUEL CA
92677-3908
US

V. Phone/Fax

Practice location:
  • Phone: 909-274-8610
  • Fax:
Mailing address:
  • Phone: 949-259-5834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. SHAHRZAD SHADMANI
Title or Position: CEO, PMHNP
Credential: NP
Phone: 909-274-8610