Healthcare Provider Details

I. General information

NPI: 1053202028
Provider Name (Legal Business Name): SHINE PSYCHIATRY PROFESSIONAL NURSING CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 12/24/2025
Certification Date: 12/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14451 CHAMBERS RD STE 110
TUSTIN CA
92780-6973
US

IV. Provider business mailing address

1054 WINGFOOT ST
PLACENTIA CA
92870-4444
US

V. Phone/Fax

Practice location:
  • Phone: 650-507-4826
  • Fax: 650-396-7917
Mailing address:
  • Phone: 714-337-8020
  • Fax: 650-396-7917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SAHIL GIRISH MEHTA
Title or Position: CEO
Credential: PMHNP
Phone: 714-337-8020