Healthcare Provider Details

I. General information

NPI: 1609506054
Provider Name (Legal Business Name): ISABELLA ACOSTA-SEGURA MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2022
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9445 FAIRWAY VIEW PL STE 100
RANCHO CUCAMONGA CA
91730-0930
US

IV. Provider business mailing address

PO BOX 932
JOSHUA TREE CA
92252-0887
US

V. Phone/Fax

Practice location:
  • Phone: 909-983-2020
  • Fax:
Mailing address:
  • Phone: 909-553-5995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number118469
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number139842
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: