Healthcare Provider Details

I. General information

NPI: 1407784648
Provider Name (Legal Business Name): MANDALA PSYCHE NURSING CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3368 VISTA HAVEN RD
SHERMAN OAKS CA
91403-4920
US

IV. Provider business mailing address

5630 VENICE BLVD STE 1085
LOS ANGELES CA
90019-5127
US

V. Phone/Fax

Practice location:
  • Phone: 323-697-7381
  • Fax: 855-295-6996
Mailing address:
  • Phone: 323-697-7381
  • Fax: 855-295-6996

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: DR. TATIANA MOLINAR
Title or Position: FOUNDR/CLINICIAN
Credential: DNP, PMHNP
Phone: 323-697-7381