Healthcare Provider Details

I. General information

NPI: 1013839711
Provider Name (Legal Business Name): MINDSET MATTERS PERFORMANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9065 HAVEN AVE STE 110
RANCHO CUCAMONGA CA
91730-5429
US

IV. Provider business mailing address

9065 HAVEN AVE STE 110
RANCHO CUCAMONGA CA
91730-5429
US

V. Phone/Fax

Practice location:
  • Phone: 909-280-4462
  • Fax:
Mailing address:
  • Phone: 909-280-4462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: CESAR PALOS
Title or Position: CEO/LPCC
Credential:
Phone: 909-738-5699