Healthcare Provider Details

I. General information

NPI: 1447715438
Provider Name (Legal Business Name): DORINA MIXON-LOWE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2019
Last Update Date: 02/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9333 BASELINE RD STE 290
RANCHO CUCAMONGA CA
91730-1300
US

IV. Provider business mailing address

9333 BASELINE RD STE 290
RANCHO CUCAMONGA CA
91730-1300
US

V. Phone/Fax

Practice location:
  • Phone: 909-755-5220
  • Fax: 951-346-3640
Mailing address:
  • Phone: 909-755-5220
  • Fax: 951-346-3640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: