Healthcare Provider Details

I. General information

NPI: 1992561377
Provider Name (Legal Business Name): AJB PROSPERITY MENTAL HEALTH, NURSING PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2024
Last Update Date: 02/25/2024
Certification Date: 02/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 VALLEY VISTA DR STE 200
DIAMOND BAR CA
91765-3921
US

IV. Provider business mailing address

1370 VALLEY VISTA DR STE 200
DIAMOND BAR CA
91765-3921
US

V. Phone/Fax

Practice location:
  • Phone: 626-384-0929
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ALAN BALDRIAS
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 626-384-0929