Healthcare Provider Details

I. General information

NPI: 1457755902
Provider Name (Legal Business Name): DENISE ANTE-CONTRERAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DENISE CONTRERAS

II. Dates (important events)

Enumeration Date: 10/13/2014
Last Update Date: 11/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1556 S SULTANA AVE
ONTARIO CA
91761-4238
US

IV. Provider business mailing address

315 N LINDEN AVE
RIALTO CA
92376-8401
US

V. Phone/Fax

Practice location:
  • Phone: 909-418-6923
  • Fax:
Mailing address:
  • Phone: 909-635-5648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: