Provider Demographics
NPI:1356228514
Name:MIND & BODY MEN'S CLINIC, A PROFESSIONAL NURSING CORPORATION
Entity type:Organization
Organization Name:MIND & BODY MEN'S CLINIC, A PROFESSIONAL NURSING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:808-269-2730
Mailing Address - Street 1:2050 LOMITA PARK PL # A
Mailing Address - Street 2:
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-1124
Mailing Address - Country:US
Mailing Address - Phone:808-269-2730
Mailing Address - Fax:
Practice Address - Street 1:720 WILSHIRE BLVD STE 204
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1737
Practice Address - Country:US
Practice Address - Phone:808-269-2730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty