Healthcare Provider Details

I. General information

NPI: 1710877303
Provider Name (Legal Business Name): CASANDRA ACEVES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E HOLT AVE STE B
POMONA CA
91767-5407
US

IV. Provider business mailing address

1976 SOSA LN
COLTON CA
92324-6610
US

V. Phone/Fax

Practice location:
  • Phone: 909-620-2521
  • Fax:
Mailing address:
  • Phone: 909-437-3801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13670
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number13670
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: