Healthcare Provider Details

I. General information

NPI: 1255854980
Provider Name (Legal Business Name): EVA GRICELDA ARTEAGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17800 US HIGHWAY 18
APPLE VALLEY CA
92307-1221
US

IV. Provider business mailing address

PO BOX 751
FONTANA CA
92334-0751
US

V. Phone/Fax

Practice location:
  • Phone: 760-552-6700
  • Fax:
Mailing address:
  • Phone: 909-600-9770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number132899
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: