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14050 Cherry Ave Ste R-1077 Fontana CA 92337-0766 | |
| (909) 279-2721 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 14050 Cherry Ave Ste R-1077, Fontana, California |
| Authorized Official Name and Position | Gabriel Anthony Reyes (MANAGER) |
| Authorized Official Contact | 9095210240 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
14050 Cherry Ave Ste R1077 Fontana CA 92337-0766 Ph: () - | 14050 Cherry Ave Ste R-1077 Fontana CA 92337-0766 Ph: (909) 279-2721 |
| NPI Number | 1285240911 |
|---|---|
| Provider Enumeration Date | 09/18/2020 |
| Last Update Date | 03/19/2021 |
| Certification Date | 03/19/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285240911 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
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