MEDICARE: FORTITUDE MENTAL HEALTH PROFESSIONAL NURSING CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0850X	Adult Mental Health Clinic/Center
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1538015193
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORTITUDE MENTAL HEALTH PROFESSIONAL NURSING CORPORATION

Provider Business Mailing Address
First Line	:	17011 BEACH BLVD STE 900
Second Line	:	PMB 850
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-5998
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5331 EL DORADO DR
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92649-4567
Country	:	US
Telephone Number	:	949-775-1785
Fax Number	:

Authorized Official
Title or Position	:	CEO / NURSE PRACTITIONER
Name	:	NICOLE CHITTUM
Credential	:	NP
Telephone Number	:	949-775-1785

Provider Enumeration Date	:	03/06/2026
Last Update Date	:	04/15/2026

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