Healthcare Provider Details

I. General information

NPI: 1245067701
Provider Name (Legal Business Name): AD MELIORA ADVANCED PRACTICE NURSING CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21550 OXNARD ST FL 3
WOODLAND HILLS CA
91367-7105
US

IV. Provider business mailing address

21550 OXNARD ST FL 3
WOODLAND HILLS CA
91367-7105
US

V. Phone/Fax

Practice location:
  • Phone: 818-435-9555
  • Fax: 747-888-5865
Mailing address:
  • Phone: 818-435-9555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VICTOR COVARRUBIAS
Title or Position: CEO
Credential: PMHNP-BC
Phone: 818-435-9555