Healthcare Provider Details

I. General information

NPI: 1285224097
Provider Name (Legal Business Name): JENNIFER LEE TAPIA PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2021
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8253 WHITE OAK AVE
RANCHO CUCAMONGA CA
91730-7671
US

IV. Provider business mailing address

3200 E GUASTI RD STE 100
ONTARIO CA
91761-8661
US

V. Phone/Fax

Practice location:
  • Phone: 909-905-5000
  • Fax: 442-327-9315
Mailing address:
  • Phone: 909-256-7824
  • Fax: 909-206-0587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number757255
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95024733
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: