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General NPI Number Information
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NPI Number | 1710577358
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Entity Type | Organization
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Legal Business Name | ESSENTIAL PSYCHIATRIC SERVICES, A PROFESSIONAL NURSING CORPORATION
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Dates
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Enumeration Date | 01/18/2021
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Last Update Date | 06/11/2023
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Provider Practice Location Address
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Address Line | 3160 W RAMSEY ST
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City | BANNING
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State | CA
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Zip | 92220-3724
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Country | US
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Telephone | 951-366-0661
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Fax | 855-706-2054
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Provider Business Mailing Address
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Address Line | 3160 W RAMSEY ST
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City | BANNING
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State | CA
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Zip | 92220-3724
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Country | US
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Telephone | 951-366-0661
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Fax | 855-706-2054
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Authorized Official
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Title or Position | CEO
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Name | JUDITH L DIAZ
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Credential | AMHNP-BC
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Telephone | 951-250-5007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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