Healthcare Provider Details

I. General information

NPI: 1144144023
Provider Name (Legal Business Name): RADIANT PATH THERAPY AND PSYCHIATRY MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4226 GREEN RIVER RD STE 201
CORONA CA
92878-3829
US

IV. Provider business mailing address

308 W STATE ST STE 3D
REDLANDS CA
92373-4653
US

V. Phone/Fax

Practice location:
  • Phone: 909-577-1123
  • Fax:
Mailing address:
  • Phone: 909-577-1123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: LANDON S EHTESHAMZADEH
Title or Position: CEO
Credential:
Phone: 909-577-1123