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General NPI Number Information
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NPI Number | 1447010723
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Entity Type | Organization
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Legal Business Name | HEALTHY MIND HEALTHCARE LLC
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Dates
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Enumeration Date | 03/21/2024
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Last Update Date | 03/21/2024
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Provider Practice Location Address
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Address Line | 6769 VERDE RIDGE RD # 700
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City | RANCHO PALOS VERDES
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State | CA
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Zip | 90275-4648
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Country | US
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Telephone | 310-702-7144
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Fax | 310-702-7144
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Provider Business Mailing Address
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Address Line | 6769 VERDE RIDGE RD # 700
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City | RANCHO PALOS VERDES
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State | CA
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Zip | 90275-4648
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Country | US
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Telephone | 310-702-7144
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Fax | 310-702-7144
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Authorized Official
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Title or Position | OWNER
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Name | VICTORIA NDUBAKU
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Credential | NP
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Telephone | 310-702-7144
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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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