Healthcare Provider Details

I. General information

NPI: 1588506331
Provider Name (Legal Business Name): IREANNE KITEAU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7890 HAVEN AVE STE.10
RANCHO CUCAMONGA CA
91730
US

IV. Provider business mailing address

3027 SPRUCE ST
RIALTO CA
92376
US

V. Phone/Fax

Practice location:
  • Phone: 909-569-3913
  • Fax:
Mailing address:
  • Phone: 909-229-6952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number46025
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: