Provider Demographics
NPI:1245067701
Name:AD MELIORA ADVANCED PRACTICE NURSING CORP
Entity type:Organization
Organization Name:AD MELIORA ADVANCED PRACTICE NURSING CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:COVARRUBIAS
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:818-435-9555
Mailing Address - Street 1:21550 OXNARD ST FL 3
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-7105
Mailing Address - Country:US
Mailing Address - Phone:818-435-9555
Mailing Address - Fax:
Practice Address - Street 1:21550 OXNARD ST FL 3
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-7105
Practice Address - Country:US
Practice Address - Phone:818-435-9555
Practice Address - Fax:747-888-5865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-18
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health