Healthcare Provider Details

I. General information

NPI: 1841738523
Provider Name (Legal Business Name): STACIE ARAGON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2017
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 OLYMPIC DR #104
CORONA CA
92881-3223
US

IV. Provider business mailing address

1100 OLYMPIC DR #104
CORONA CA
92881-3223
US

V. Phone/Fax

Practice location:
  • Phone: 714-330-2613
  • Fax: 951-280-9866
Mailing address:
  • Phone: 714-330-2613
  • Fax: 951-280-9866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: STACIE ARAGON
Title or Position: PRESIDENT/LCSW
Credential:
Phone: 714-330-2613