Healthcare Provider Details

I. General information

NPI: 1770803546
Provider Name (Legal Business Name): BUILDING A GENERATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 06/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 CRAFTON AVE
MENTONE CA
92359-1318
US

IV. Provider business mailing address

129 E VINE ST
REDLANDS CA
92373-4759
US

V. Phone/Fax

Practice location:
  • Phone: 909-794-7753
  • Fax: 909-793-8823
Mailing address:
  • Phone: 909-793-8822
  • Fax: 909-793-8823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MELINDA CORRAL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 909-793-8822