Healthcare Provider Details

I. General information

NPI: 1255045142
Provider Name (Legal Business Name): PRISM NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

21600 OXNARD ST STE 1030
WOODLAND HILLS CA
91367-5085
US

IV. Provider business mailing address

21600 OXNARD ST STE 1030
WOODLAND HILLS CA
91367-5085
US

V. Phone/Fax

Practice location:
  • Phone: 877-206-1009
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: MAYLENE DURAN
Title or Position: ENTRY LEVEL BEHAVIORIST INTERVENTIO
Credential:
Phone: 951-293-9886