Provider Demographics
NPI:1215800669
Name:CA PSYCHIATRY & MENTAL HEALTH NURSING PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:CA PSYCHIATRY & MENTAL HEALTH NURSING PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARLON CARLO
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTELA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, PMHNP-BC
Authorized Official - Phone:661-339-4306
Mailing Address - Street 1:540 W RANCHO VISTA BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-3010
Mailing Address - Country:US
Mailing Address - Phone:661-339-4306
Mailing Address - Fax:
Practice Address - Street 1:540 W RANCHO VISTA BLVD STE 102
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3010
Practice Address - Country:US
Practice Address - Phone:661-339-4306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)