Provider Demographics
NPI:1821961020
Name:MINDSCAPE JOURNEYS NURSING CORPORATION
Entity type:Organization
Organization Name:MINDSCAPE JOURNEYS NURSING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:424-728-5564
Mailing Address - Street 1:2200 PACIFIC COAST HWY STE 103
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-2700
Mailing Address - Country:US
Mailing Address - Phone:424-728-5564
Mailing Address - Fax:424-377-6548
Practice Address - Street 1:2200 PACIFIC COAST HWY STE 103
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2700
Practice Address - Country:US
Practice Address - Phone:424-728-5564
Practice Address - Fax:424-377-6548
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COASTAL MINDSCAPE NURSING CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty