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General NPI Number Information
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NPI Number | 1821961020
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Entity Type | Organization
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Legal Business Name | MINDSCAPE JOURNEYS NURSING CORPORATION
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Dates
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Enumeration Date | 09/25/2025
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 2200 PACIFIC COAST HWY STE 103
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City | HERMOSA BEACH
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State | CA
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Zip | 90254-2700
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Country | US
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Telephone | 424-728-5564
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Fax | 424-377-6548
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Provider Business Mailing Address
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Address Line | 2200 PACIFIC COAST HWY STE 103
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City | HERMOSA BEACH
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State | CA
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Zip | 90254-2700
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Country | US
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Telephone | 424-728-5564
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Fax | 424-377-6548
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Authorized Official
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Title or Position | PRESIDENT
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Name | DYANA KO
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Credential | NP
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Telephone | 424-728-5564
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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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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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