Healthcare Provider Details

I. General information

NPI: 1174212526
Provider Name (Legal Business Name): DENISE D CONTRERAS MASSGE THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14910 SUMMIT AVE STE 29
FONTANA CA
92336-5386
US

IV. Provider business mailing address

14910 SUMMIT AVE STE 29
FONTANA CA
92336-5386
US

V. Phone/Fax

Practice location:
  • Phone: 562-205-7053
  • Fax: 909-951-2317
Mailing address:
  • Phone: 562-205-7053
  • Fax: 909-951-2317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number88237
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: