Provider Demographics
NPI:1205649084
Name:MINERVAPSYCH, A PROFESSIONAL NURSING CORPORATION
Entity type:Organization
Organization Name:MINERVAPSYCH, A PROFESSIONAL NURSING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CATARINA
Authorized Official - Middle Name:FAVALLI
Authorized Official - Last Name:FLEURY
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:410-530-8090
Mailing Address - Street 1:5205 HOLLYWOOD BLVD STE 216
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-4914
Mailing Address - Country:US
Mailing Address - Phone:213-762-9451
Mailing Address - Fax:209-392-4667
Practice Address - Street 1:5205 HOLLYWOOD BLVD STE 216
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-4914
Practice Address - Country:US
Practice Address - Phone:213-762-9451
Practice Address - Fax:209-392-4667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty