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NPI Code Detail

MEDICARE: NUEVA VIDA PSYCHIATRY, A PROFESSIONAL NURSING CORPORATION

MEDICARE: NUEVA VIDA PSYCHIATRY, A PROFESSIONAL NURSING CORPORATION
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number : 1568318582
Entity Type Code : Organization
Provider Name (Legal Business Name) : NUEVA VIDA PSYCHIATRY, A PROFESSIONAL NURSING CORPORATION
Provider Business Mailing Address
First Line : 1849 SAWTELLE BLVD STE 610
Second Line :
City : LOS ANGELES
State : CA
Zip : 90025-7013
Country : US
Telephone Number : 310-361-8043
Fax Number : 310-986-8241
Provider Business Practice Location Address
First Line : 1849 SAWTELLE BLVD STE 610
Second Line :
City : LOS ANGELES
State : CA
Zip : 90025-7013
Country : US
Telephone Number : 310-361-8043
Fax Number : 310-986-8241
Authorized Official
Title or Position : OWNER
Name : STEPHANIE LARSEN
Credential : NP
Telephone Number : 310-730-9236
Provider Enumeration Date : 03/10/2026
Last Update Date : 03/10/2026

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Directions to “NUEVA VIDA PSYCHIATRY, A PROFESSIONAL NURSING CORPORATION ” Practice Location

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