Healthcare Provider Details

I. General information

NPI: 1568694073
Provider Name (Legal Business Name): SAYIDA PEPRAH-WILSON PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2009
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6371 HAVEN AVE STE 3-224
RANCHO CUCAMONGA CA
91737-6943
US

IV. Provider business mailing address

6371 HAVEN AVE STE 3-224
RANCHO CUCAMONGA CA
91737-6943
US

V. Phone/Fax

Practice location:
  • Phone: 626-233-6548
  • Fax:
Mailing address:
  • Phone: 626-233-6548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number30299
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: