Healthcare Provider Details

I. General information

NPI: 1598235061
Provider Name (Legal Business Name): STEPHANIA CID
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2018
Last Update Date: 11/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1987 FIG TREE RD
COLTON CA
92324-8464
US

IV. Provider business mailing address

1987 FIG TREE RD
COLTON CA
92324-8464
US

V. Phone/Fax

Practice location:
  • Phone: 909-659-8943
  • Fax:
Mailing address:
  • Phone: 909-659-8943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: