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NPI Code Detail

MEDICARE: KEVIN FESTA

MEDICARE: KEVIN FESTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2106S00000XBehavior TechnicianCA
3175T00000XPeer Specialist

General Provider Information

NPI Number : 1639368228
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEVIN FESTA
Provider Business Mailing Address
First Line : 11799 SEBASTIAN WAY STE 103
Second Line :
City : RANCHO CUCAMONGA
State : CA
Zip : 91730-0708
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11799 SEBASTIAN WAY STE 103
Second Line :
City : RANCHO CUCAMONGA
State : CA
Zip : 91730-0708
Country : US
Telephone Number : 909-353-7547
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2007
Last Update Date : 10/27/2025

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Directions to “ KEVIN FESTA ” Practice Location

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