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General NPI Number Information
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NPI Number | 1417604422
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Entity Type | Organization
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Legal Business Name | MINDWORKS CONNECTION PROFESSIONAL NURSING CORPORATION
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Dates
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Enumeration Date | 03/09/2022
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Last Update Date | 04/25/2022
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Provider Practice Location Address
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Address Line | MINDWORKS CONNECTION 1968 S COAST HWY # 4560
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-3681
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Country | US
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Telephone | 425-615-4312
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Fax |
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Provider Business Mailing Address
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Address Line | 1968 S COAST HWY # 4560
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-3681
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Country | US
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Telephone | 425-615-4312
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KUMBIRAI MADIYE
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Credential | PMHNP-BC
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Telephone | 808-221-1039
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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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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