Healthcare Provider Details

I. General information

NPI: 1275429474
Provider Name (Legal Business Name): DLB RANCH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 06/16/2025
Certification Date: 06/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17596 SOUTHLAKE RD
COTTONWOOD CA
96022-9041
US

IV. Provider business mailing address

17596 SOUTHLAKE RD
COTTONWOOD CA
96022-9041
US

V. Phone/Fax

Practice location:
  • Phone: 530-360-0427
  • Fax:
Mailing address:
  • Phone: 530-360-0427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. JONI MAGGINI
Title or Position: PRESIDENT
Credential:
Phone: 530-360-0427