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General NPI Number Information
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NPI Number | 1487582540
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Entity Type | Organization
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Legal Business Name | ORANGE PACIFIC MENTAL HEALTH, PROFESSIONAL NURSING CORPORATION
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Dates
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Enumeration Date | 05/11/2026
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Last Update Date | 05/11/2026
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Provider Practice Location Address
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Address Line | 201 N BRAND BLVD UNIT 200
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City | GLENDALE
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State | CA
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Zip | 91203-3590
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Country | US
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Telephone | 503-987-3135
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Fax | 503-388-7333
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Provider Business Mailing Address
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Address Line | 3935 NORMAL ST APT 309
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City | SAN DIEGO
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State | CA
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Zip | 92103-3588
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Country | US
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Telephone | 503-987-3135
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Fax | 503-388-7333
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Authorized Official
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Title or Position | OWNER
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Name | TIMOTHY KORM
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Credential | PMHNP-BC
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Telephone | 978-328-3023
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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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