Healthcare Provider Details

I. General information

NPI: 1194638148
Provider Name (Legal Business Name): KETTERMAN WELLBEING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5033 CARRIAGE RD
RANCHO CUCAMONGA CA
91737-1685
US

IV. Provider business mailing address

5033 CARRIAGE RD
RANCHO CUCAMONGA CA
91737-1685
US

V. Phone/Fax

Practice location:
  • Phone: 909-732-6224
  • Fax: 909-466-7867
Mailing address:
  • Phone: 909-732-6224
  • Fax: 909-466-7867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. DIANA PATRICIA CHAVEZ KETTERMAN
Title or Position: OWNER
Credential: PHD
Phone: 909-732-6224