Healthcare Provider Details

I. General information

NPI: 1689515041
Provider Name (Legal Business Name): JOHANA BEATRIZ UGARTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18300 US HIGHWAY 18
APPLE VALLEY CA
92307-2206
US

IV. Provider business mailing address

13409 WACO LN
APPLE VALLEY CA
92308-6277
US

V. Phone/Fax

Practice location:
  • Phone: 760-242-2311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: