Individual provider Active NPI

J Paul Gatdula, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Newport Beach, CA
National Provider Identifier
1225727258
Registry record updated Aug 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
95025054 Issued in CA
Practice address
2618 San Miguel Dr # 2151
Newport Beach, CA 92660-5437
Phone
(949) 996-8342
Fax
(949) 996-8038
NPI assigned
May 4, 2023
Last updated
Aug 21, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 95025054 CA Primary

Addresses

Primary practice location

2618 San Miguel Dr # 2151
Newport Beach, CA 92660-5437

Mailing address

2618 San Miguel Dr # 2151
Newport Beach, CA 92660-5437
Phone (949) 996-8342

Other practice location 1

1000 Quail St Ste 200
Newport Beach, CA 92660-2767
Phone (714) 369-8052

Other practice location 2

1225 W 190th St Ste 280
Gardena, CA 90248-4305
Phone (877) 515-8113

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230613001978 CA Practitioner - Nurse Practitioner 4587021142 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ehab Yacoub MD Inc. CurrentSince Jun 5, 2023 Accepting new patients
North Star Psychiatry, a Professional Nursing Corporation Psychiatric/Mental Health PastSince May 1, 2023 Accepting new patients

Locations

1225 W 190th St
Ste 280
Gardena, CA 90248
Phone (310) 515-8113

17075 Devonshire St
Ste 204
Northridge, CA 91325
Phone (818) 368-8929

14541 Delano St
Van Nuys, CA 91411
Phone (310) 515-8113

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1683158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787270400000",
    "number": "1225727258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2618 SAN MIGUEL DR # 2151",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926605437",
            "telephone_number": "949-996-8342",
            "fax_number": "949-996-8038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2618 SAN MIGUEL DR # 2151",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926605437",
            "telephone_number": "949-996-8342",
            "fax_number": "949-996-8038"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 Quail St Ste 200",
            "address_purpose": "LOCATION",
            "city": "Newport Beach",
            "state": "CA",
            "postal_code": "926602767",
            "country_code": "US",
            "telephone_number": "714-369-8052",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1225 W 190th St Ste 280",
            "address_purpose": "LOCATION",
            "city": "Gardena",
            "state": "CA",
            "postal_code": "902484305",
            "country_code": "US",
            "telephone_number": "877-515-8113",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GATDULA",
        "first_name": "J PAUL",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-05-04",
        "last_updated": "2026-08-21",
        "certification_date": "2026-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95025054",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newport Beach, CA

Sources for this page

Verify at the official NPI Registry.