1972258796 NPI number — OPNMYND LLC

Table of content: (NPI 1972258796)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972258796 NPI number — OPNMYND LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPNMYND LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MINDLOFT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972258796
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3340
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUSTIN
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92781-3340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-569-9226
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
525 S GOOD LATIMER EXPY
Provider Second Line Business Practice Location Address:
#7211
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-569-9173
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/21/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WERNER
Authorized Official First Name:
DALE
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING PRINCIPAL
Authorized Official Telephone Number:
949-569-9226

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TB0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC1900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TP0814X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TP2701X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)