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1710577358 NPI number — ESSENTIAL PSYCHIATRIC SERVICES, A PROFESSIONAL NURSING CORPORATION

NPI Number: 1710577358
Health Care Provider/Practitioner: ESSENTIAL PSYCHIATRIC SERVICES, A PROFESSIONAL NURSING CORPORATION

Information about “1710577358” NPI (ESSENTIAL PSYCHIATRIC SERVICES, A PROFESSIONAL NURSING CORPORATION) exists in 1710577358 in HTML format HTML  |  1710577358 in plain Text format TXT  |  1710577358 in PDF (Portable Document Format) PDF  |  1710577358 in an XML format XML  formats.

NPI Number : 1710577358 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1710577358",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "ESSENTIAL PSYCHIATRIC SERVICES, A PROFESSIONAL NURSING CORPORATION",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3160 W RAMSEY ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BANNING",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92220-3724",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "951-366-0661",
    "MailingAddressFaxNumber": "855-706-2054",
    "FirstLinePracticeLocationAddress": "3160 W RAMSEY ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BANNING",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92220-3724",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "951-366-0661",
    "PracticeLocationAddressFaxNumber": "855-706-2054",
    "EnumerationDate": "01/18/2021",
    "LastUpdateDate": "06/11/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "DIAZ",
    "AuthorizedOfficialFirstName": "JUDITH",
    "AuthorizedOfficialMiddleName": "L",
    "AuthorizedOfficialTitle": "CEO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "AMHNP-BC",
    "AuthorizedOfficialTelephoneNumber": "951-250-5007",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QM0850X",
        "TaxonomyName": "Adult Mental Health Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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