Healthcare Provider Details

I. General information

NPI: 1447727383
Provider Name (Legal Business Name): VALERIE CORREA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2018
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date: 06/17/2019
Reactivation Date: 06/27/2019

III. Provider practice location address

5555 HOWARD ST.
ONTARIO CA
91762224
US

IV. Provider business mailing address

9500 HAVEN AVE
RANCHO CUCAMONGA CA
91730-5807
US

V. Phone/Fax

Practice location:
  • Phone: 909-459-2500
  • Fax:
Mailing address:
  • Phone: 909-980-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: