Provider Demographics
NPI:1023586716
Name:MIND OASIS PSYCHIATRY, A PROFESSIONAL NURSING CORPORATION
Entity type:Organization
Organization Name:MIND OASIS PSYCHIATRY, A PROFESSIONAL NURSING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CAROLAIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:PEREGRINO
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:408-484-7012
Mailing Address - Street 1:60 W MAIN AVE STE 11A
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-4553
Mailing Address - Country:US
Mailing Address - Phone:408-484-7012
Mailing Address - Fax:
Practice Address - Street 1:60 W MAIN AVE STE 11A
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-4553
Practice Address - Country:US
Practice Address - Phone:408-484-7012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1740639301Medicaid