Healthcare Provider Details

I. General information

NPI: 1225952591
Provider Name (Legal Business Name): ACUARELA ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21229 GLENORA DR
APPLE VALLEY CA
92308-5850
US

IV. Provider business mailing address

PO BOX 3206
VICTORVILLE CA
92393-3206
US

V. Phone/Fax

Practice location:
  • Phone: 760-881-8968
  • Fax:
Mailing address:
  • Phone: 760-881-8968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: NELCY YOHANNA TAMAYO MANRIQUE
Title or Position: THERAPIST
Credential: LMFT
Phone: 760-881-8968