Healthcare Provider Details

I. General information

NPI: 1114840816
Provider Name (Legal Business Name): LLPMG APPLE VALLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18522 US HIGHWAY 18 STE 206
APPLE VALLEY CA
92307-2321
US

IV. Provider business mailing address

PO BOX 1303
LOMA LINDA CA
92354-1303
US

V. Phone/Fax

Practice location:
  • Phone: 760-946-4664
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LIBERTY OLIVE MACIAS
Title or Position: CEO
Credential: NP
Phone: 909-900-6465