Healthcare Provider Details

I. General information

NPI: 1710577358
Provider Name (Legal Business Name): ESSENTIAL PSYCHIATRIC SERVICES, A PROFESSIONAL NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2021
Last Update Date: 06/11/2023
Certification Date: 06/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3160 W RAMSEY ST
BANNING CA
92220-3724
US

IV. Provider business mailing address

3160 W RAMSEY ST
BANNING CA
92220-3724
US

V. Phone/Fax

Practice location:
  • Phone: 951-366-0661
  • Fax: 855-706-2054
Mailing address:
  • Phone: 951-366-0661
  • Fax: 855-706-2054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JUDITH L DIAZ
Title or Position: CEO
Credential: AMHNP-BC
Phone: 951-250-5007