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Organization
PRISM NETWORK
Active
Organization
PRISM NETWORK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAYLENE DURAN (ENTRY LEVEL BEHAVIORIST INTERVENTIO)
(951) 293-9886
Entity
Organization
Contact information
Practice address
21600 OXNARD ST STE 1030, WOODLAND HILLS, CA 91367-5085
(877) 206-1009
Mailing address
21600 OXNARD ST STE 1030, WOODLAND HILLS, CA 91367-5085
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20040600128100
MEDICAL
CA
Enumeration date
01/06/2023
Last updated
01/06/2023
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