Healthcare Provider Details

I. General information

NPI: 1811456478
Provider Name (Legal Business Name): PMNI, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2019
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 DEEP VALLEY DR STE 241
ROLLING HILLS ESTATES CA
90274-3629
US

IV. Provider business mailing address

5776D LINDERO CANYON RD STE 469
WESTLAKE VILLAGE CA
91362-4088
US

V. Phone/Fax

Practice location:
  • Phone: 310-378-0547
  • Fax:
Mailing address:
  • Phone: 310-378-0547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: VANESSA JUNG
Title or Position: CLINICAL DIRECTOR
Credential: PSY.D.
Phone: 310-378-0547