Healthcare Provider Details

I. General information

NPI: 1356183255
Provider Name (Legal Business Name): ARIES JOJO L CABUANG II AMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 W 1ST ST STE 250
CLAREMONT CA
91711-4745
US

IV. Provider business mailing address

250 W 1ST ST STE 250
CLAREMONT CA
91711-4745
US

V. Phone/Fax

Practice location:
  • Phone: 909-624-1997
  • Fax: 909-624-4409
Mailing address:
  • Phone: 909-624-1997
  • Fax: 909-624-4409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number139973
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: