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General NPI Number Information
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NPI Number | 1104738848
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Entity Type | Organization
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Legal Business Name | MINDSCAPE PSYCHIATRIC WELLNESS NURSING CORPORATION
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Dates
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Enumeration Date | 09/18/2026
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Last Update Date | 09/18/2026
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Provider Practice Location Address
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Address Line | 915 HIGHLAND POINTE DR STE 250
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City | ROSEVILLE
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State | CA
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Zip | 95678-5421
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Country | US
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Telephone | 805-766-0268
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Fax |
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Provider Business Mailing Address
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Address Line | 915 HIGHLAND POINTE DR STE 250
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City | ROSEVILLE
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State | CA
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Zip | 95678-5421
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Country | US
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Telephone | 805-766-0268
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Fax |
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Authorized Official
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Title or Position | NP
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Name | REX AMBATALI
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Credential | MSN, PMHNP-BC
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Telephone | 805-766-0268
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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