=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306751755
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH STAR PSYCHIATRY, A PROFESSIONAL NURSING CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2026
-----------------------------------------------------
Last Update Date | 08/18/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18885 DEODAR ST
-----------------------------------------------------
City | FOUNTAIN VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92708-7222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-996-8342
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2618 SAN MIGUEL DR # 2151
-----------------------------------------------------
City | NEWPORT BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92660-5437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-996-8342
-----------------------------------------------------
Fax | 949-996-8038
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHIATRIC NP / FOUNDER
-----------------------------------------------------
Name | J PAUL GATDULA
-----------------------------------------------------
Credential | PMHNP-BC
-----------------------------------------------------
Telephone | 949-996-8342
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------