Healthcare Provider Details

I. General information

NPI: 1629959150
Provider Name (Legal Business Name): BUBBLEGUM AND DUCT TAPE WELLNESS P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 NE BELKNAP CT
HILLSBORO OR
97124-6467
US

IV. Provider business mailing address

901 H ST STE 120
SACRAMENTO CA
95814-1817
US

V. Phone/Fax

Practice location:
  • Phone: 844-966-5349
  • Fax: 949-703-8913
Mailing address:
  • Phone: 844-966-5349
  • Fax: 770-764-2950

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: DISHINA SINGER
Title or Position: OWNER
Credential: DNP, PMHNP-BC
Phone: 619-886-4055