Healthcare Provider Details

I. General information

NPI: 1285578989
Provider Name (Legal Business Name): DIVINE INSIGHT FAMILY THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9431 HAVEN AVE STE 116
RANCHO CUCAMONGA CA
91730-5880
US

IV. Provider business mailing address

9431 HAVEN AVE STE 116
RANCHO CUCAMONGA CA
91730-5880
US

V. Phone/Fax

Practice location:
  • Phone: 909-808-2908
  • Fax:
Mailing address:
  • Phone: 909-808-2908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. ASTRID GANDARA
Title or Position: PRESIDENT
Credential: LMFT
Phone: 909-808-2908