Provider Demographics
NPI:1851093256
Name:DYMPHNA PSYCHIATRIC NURSING & WELLNESS, PC
Entity Type:Organization
Organization Name:DYMPHNA PSYCHIATRIC NURSING & WELLNESS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROHZAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTRE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:707-590-8432
Mailing Address - Street 1:14256 ASTORIA ST
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-4121
Mailing Address - Country:US
Mailing Address - Phone:707-853-0143
Mailing Address - Fax:
Practice Address - Street 1:22408 SHERMAN WAY
Practice Address - Street 2:STE 115
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-9130
Practice Address - Country:US
Practice Address - Phone:707-853-0143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-20
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty