Healthcare Provider Details

I. General information

NPI: 1811390644
Provider Name (Legal Business Name): APRIL LOTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2014
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17053 FOOTHILL BLVD BLDG B
FONTANA CA
92335
US

IV. Provider business mailing address

1950 S SUNWEST LN
SAN BERNARDINO CA
92408-3258
US

V. Phone/Fax

Practice location:
  • Phone: 909-347-1300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW72082
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number90333
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: