Healthcare Provider Details

I. General information

NPI: 1285590109
Provider Name (Legal Business Name): PROSPECT LEARNING AND DEVELOPMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 COTTAGE WAY STE G2
SACRAMENTO CA
95825-1474
US

IV. Provider business mailing address

3400 COTTAGE WAY STE G2
SACRAMENTO CA
95825-1474
US

V. Phone/Fax

Practice location:
  • Phone: 347-921-3250
  • Fax: 347-779-0433
Mailing address:
  • Phone: 347-921-3250
  • Fax: 347-779-0433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: JOSE RICARDO DIAZ
Title or Position: PROGRAM ADMIN
Credential:
Phone: 347-921-3250