Healthcare Provider Details

I. General information

NPI: 1891650438
Provider Name (Legal Business Name): MS. SHAQUITA TIMOTHY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1799 SEBASTAIN WAY SUIT 103
RANCHO CUCAMONGA CA
91730
US

IV. Provider business mailing address

1799 SEBASTAIN WAY SUIT 103
RANCHO CUCAMONGA CA
91730
US

V. Phone/Fax

Practice location:
  • Phone: 951-531-5399
  • Fax:
Mailing address:
  • Phone: 951-531-5399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: