Organization
MINDFUL GLOW
Active
Other names
Mindful Glow Medical Corporation, Mindful Glow Inc
Organization subpart
No
Provider details
NPI number
Authorized official
TAM DO PMHNP, FNP (CEO)
(949) 436-4666
Entity
Organization
Contact information
Practice address
18111 BROOKHURST ST STE 5400, FOUNTAIN VALLEY, CA 92708-6728
(949) 436-4666
Mailing address
18111 BROOKHURST ST STE 5400, FOUNTAIN VALLEY, CA 92708-6728
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
261QM2500X
Medical Specialty Clinic/Center
—
—
Other
Enumeration date
02/15/2025
Last updated
04/11/2025
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