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NPI Code Detail

MEDICARE: PRO HEALTH PSYCHIATRY NURSING CORPORATION

MEDICARE: PRO HEALTH PSYCHIATRY 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 : 1932972247
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRO HEALTH PSYCHIATRY NURSING CORPORATION
Provider Business Mailing Address
First Line : 4533 MACARTHUR BLVD STE A-2068
Second Line :
City : NEWPORT BEACH
State : CA
Zip : 92660-2059
Country : US
Telephone Number : 562-833-0518
Fax Number :
Provider Business Practice Location Address
First Line : 1 PARK PLZ STE 600
Second Line :
City : IRVINE
State : CA
Zip : 92614-5987
Country : US
Telephone Number : 949-828-1546
Fax Number :
Authorized Official
Title or Position : CEO
Name : JACOB OLSEN
Credential : PMHNP
Telephone Number : 562-833-0518
Provider Enumeration Date : 10/30/2023
Last Update Date : 03/06/2026

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Directions to “PRO HEALTH PSYCHIATRY NURSING CORPORATION ” Practice Location

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