Healthcare Provider Details

I. General information

NPI: 1750244711
Provider Name (Legal Business Name): MR. RANDALL CONTRERAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2025
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15229 AMAR RD
LA PUENTE CA
91744-2003
US

IV. Provider business mailing address

2180 VALLEY BLVD
POMONA CA
91768-3325
US

V. Phone/Fax

Practice location:
  • Phone: 626-855-5090
  • Fax:
Mailing address:
  • Phone: 424-456-8681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: