Healthcare Provider Details

I. General information

NPI: 1417100256
Provider Name (Legal Business Name): JASMINE RONQUILLO DEGUZMAN M.A., LMFT #117289
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2008
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
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: 909-757-5770
  • Fax: 909-757-7276
Mailing address:
  • Phone: 909-757-5770
  • Fax: 909-757-7276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMFT 69934
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: