Healthcare Provider Details

I. General information

NPI: 1730941675
Provider Name (Legal Business Name): RESTORING VIDA THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2024
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11175 AZUSA CT STE 110
RANCHO CUCAMONGA CA
91730-4933
US

IV. Provider business mailing address

11175 AZUSA CT STE 110
RANCHO CUCAMONGA CA
91730-4933
US

V. Phone/Fax

Practice location:
  • Phone: 909-962-1485
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: SAUL SALMERON
Title or Position: PRESIDENT
Credential:
Phone: 909-962-1485