Healthcare Provider Details

I. General information

NPI: 1346173986
Provider Name (Legal Business Name): JUSTINA SERVANTES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3355 MOUNTAIN GATE DR
CORONA CA
92882-8858
US

IV. Provider business mailing address

2820 CLARK AVE
NORCO CA
92860-1903
US

V. Phone/Fax

Practice location:
  • Phone: 951-739-5960
  • Fax:
Mailing address:
  • Phone: 951-736-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: