Healthcare Provider Details

I. General information

NPI: 1194479501
Provider Name (Legal Business Name): NEBULA HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2022
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6833 INDIANA AVE STE 101
RIVERSIDE CA
92506-4223
US

IV. Provider business mailing address

806 AVENIDA PICO # I-330
SAN CLEMENTE CA
92673-5639
US

V. Phone/Fax

Practice location:
  • Phone: 951-289-5424
  • Fax:
Mailing address:
  • Phone: 657-346-6319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEEPAK RAJPOOT
Title or Position: CEO
Credential: MD
Phone: 775-550-7401