Healthcare Provider Details

I. General information

NPI: 1619429891
Provider Name (Legal Business Name): STEPHANIE MICHELLE TRONCOSO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2016
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9445 FAIRWAY VIEW PL STE 210
RANCHO CUCAMONGA CA
91730-0931
US

IV. Provider business mailing address

9445 FAIRWAY VIEW PL STE 210
RANCHO CUCAMONGA CA
91730-0931
US

V. Phone/Fax

Practice location:
  • Phone: 909-983-2020
  • Fax:
Mailing address:
  • Phone: 909-983-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number108422
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: