Provider Demographics
NPI:1679328058
Name:AFFINITY PSYCHIATRIC NURSING SERVICES, PC
Entity Type:Organization
Organization Name:AFFINITY PSYCHIATRIC NURSING SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MWAURA
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:909-714-7917
Mailing Address - Street 1:1968 S COAST HWY # 4177
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-3681
Mailing Address - Country:US
Mailing Address - Phone:909-714-7917
Mailing Address - Fax:
Practice Address - Street 1:13781 AMBERVIEW PL
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-5530
Practice Address - Country:US
Practice Address - Phone:909-714-7917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty