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General NPI Number Information
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NPI Number | 1205649084
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Entity Type | Organization
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Legal Business Name | MINERVAPSYCH, A PROFESSIONAL NURSING CORPORATION
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Dates
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Enumeration Date | 01/27/2025
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 5205 HOLLYWOOD BLVD STE 216
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City | LOS ANGELES
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State | CA
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Zip | 90027-4914
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Country | US
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Telephone | 213-762-9451
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Fax | 209-392-4667
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Provider Business Mailing Address
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Address Line | 5205 HOLLYWOOD BLVD STE 216
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City | LOS ANGELES
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State | CA
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Zip | 90027-4914
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Country | US
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Telephone | 213-762-9451
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Fax | 209-392-4667
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Authorized Official
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Title or Position | PRESIDENT
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Name | CATARINA FAVALLI FLEURY
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Credential | PMHNP-BC
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Telephone | 410-530-8090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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