Healthcare Provider Details

I. General information

NPI: 1265193957
Provider Name (Legal Business Name): INLAND VALLEY PSYCHOLOGICAL AND ASSESSMENT SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13051 CENTRAL AVE
CHINO CA
91710-4124
US

IV. Provider business mailing address

7056 ARCHIBALD AVE STE 102-249
EASTVALE CA
92880-8713
US

V. Phone/Fax

Practice location:
  • Phone: 951-422-2941
  • Fax:
Mailing address:
  • Phone: 951-422-2941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ADRIAN MICHELLE CAMARGO RUBLY
Title or Position: CFO/CEO/SECRETARY/ DIRECTOR
Credential: PSYD
Phone: 951-422-2941