MEDICARE: MANDALA PSYCHE NURSING CORP

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1588500201
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANDALA PSYCHE NURSING CORP

Provider Business Mailing Address
First Line	:	5630 VENICE BLVD STE 1085
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-5127
Country	:	US
Telephone Number	:	626-489-1060
Fax Number	:	855-295-6996

Provider Business Practice Location Address
First Line	:	1424 W 45TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90062-2040
Country	:	US
Telephone Number	:	323-697-7381
Fax Number	:	323-697-7381

Authorized Official
Title or Position	:	FOUNDER/CLINICIAN
Name	:	DR. TATIANA MOLINAR
Credential	:	DNP, PMHNP
Telephone Number	:	626-489-1060

Provider Enumeration Date	:	04/25/2026
Last Update Date	:	04/27/2026

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