Healthcare Provider Details

I. General information

NPI: 1326172966
Provider Name (Legal Business Name): PAUL TERRAZAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17830 ARROW BLVD
FONTANA CA
92335-4037
US

IV. Provider business mailing address

17830 ARROW BLVD
FONTANA CA
92335-4037
US

V. Phone/Fax

Practice location:
  • Phone: 909-356-6439
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number7671
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW82674
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: