Healthcare Provider Details

I. General information

NPI: 1821424615
Provider Name (Legal Business Name): MS. MICHELLE PINON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2013
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16854 IVY AVE STE A
FONTANA CA
92335-1504
US

IV. Provider business mailing address

16465 SIERRA LAKES PKWY STE 115
FONTANA CA
92336-1242
US

V. Phone/Fax

Practice location:
  • Phone: 909-791-1000
  • Fax: 909-781-6000
Mailing address:
  • Phone: 909-823-8000
  • Fax: 909-823-8088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF83646
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: