Healthcare Provider Details

I. General information

NPI: 1760139174
Provider Name (Legal Business Name): IESHA FREEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2022
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16594 ARROW BLVD APT 26
FONTANA CA
92335-0342
US

IV. Provider business mailing address

12678 MEMORIAL WAY APT 2032
MORENO VALLEY CA
92553-2027
US

V. Phone/Fax

Practice location:
  • Phone: 213-531-6089
  • Fax:
Mailing address:
  • Phone: 213-531-6089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: