Healthcare Provider Details

I. General information

NPI: 1205649084
Provider Name (Legal Business Name): MINERVAPSYCH, A PROFESSIONAL NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 S IVY AVE
MONROVIA CA
91016-2827
US

IV. Provider business mailing address

517 S IVY AVE
MONROVIA CA
91016-2827
US

V. Phone/Fax

Practice location:
  • Phone: 213-762-9451
  • Fax: 209-392-4667
Mailing address:
  • Phone: 213-762-9451
  • Fax: 209-392-4667

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: CATARINA FAVALLI FLEURY
Title or Position: PRESIDENT
Credential: PMHNP-BC
Phone: 410-530-8090