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General NPI Number Information
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NPI Number | 1275330656
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Entity Type | Individual
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Provider Name | ULTIMA ACAIN PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 02/25/2025
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 6245 DELONGPRE AVE 2ND FLOOR
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City | LOS ANGELES
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State | CA
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Zip | 90028
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Country | US
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Telephone | 888-783-1883
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Fax |
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Provider Business Mailing Address
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Address Line | 19685 MARTELLUS DR
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City | SANTA CLARITA
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State | CA
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Zip | 91350-3986
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Country | US
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Telephone | 818-602-9730
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 77788992
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License Number State | CA
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