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General NPI Number Information
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NPI Number | 1356228514
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Entity Type | Organization
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Legal Business Name | MIND & BODY MEN'S CLINIC, A PROFESSIONAL NURSING CORPORATION
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Dates
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Enumeration Date | 08/19/2025
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 720 WILSHIRE BLVD STE 204
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City | SANTA MONICA
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State | CA
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Zip | 90401-1737
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Country | US
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Telephone | 808-269-2730
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Fax |
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Provider Business Mailing Address
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Address Line | 2050 LOMITA PARK PL # A
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City | LOMITA
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State | CA
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Zip | 90717-1124
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Country | US
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Telephone | 808-269-2730
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Fax |
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Authorized Official
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Title or Position | OWNER AND PROVIDER
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Name | JOSEPH WILKINSON
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Credential | PMHNP
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Telephone | 808-269-2730
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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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