Provider Demographics
NPI:1700637956
Name:AVID MENTAL HEALTH A PROFESSIONAL NURSING CORPORATION
Entity Type:Organization
Organization Name:AVID MENTAL HEALTH A PROFESSIONAL NURSING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:JUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-461-4121
Mailing Address - Street 1:2050 N TUSTIN ST # 1036
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-3902
Mailing Address - Country:US
Mailing Address - Phone:714-461-4121
Mailing Address - Fax:
Practice Address - Street 1:1820 W ORANGEWOOD AVE STE 104
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-5051
Practice Address - Country:US
Practice Address - Phone:714-461-4121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty