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General NPI Number Information
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NPI Number | 1649989104
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Entity Type | Organization
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Legal Business Name | BLUE OCEAN MENTAL HEALTH
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Dates
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Enumeration Date | 11/22/2022
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Last Update Date | 12/27/2022
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Provider Practice Location Address
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Address Line | 4143 VIA MARINA APT 912
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City | MARINA DEL REY
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State | CA
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Zip | 90292-5308
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Country | US
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Telephone | 323-553-1114
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Fax |
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Provider Business Mailing Address
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Address Line | 4143 VIA MARINA APT 912
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City | MARINA DEL REY
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State | CA
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Zip | 90292-5308
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | ESDER SHIN
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Credential | NP
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Telephone | 917-714-9696
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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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