Healthcare Provider Details

I. General information

NPI: 1033023122
Provider Name (Legal Business Name): OSCAR BACA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10825 ARROW RTE
RANCHO CUCAMONGA CA
91730-4800
US

IV. Provider business mailing address

10825 ARROW RTE
RANCHO CUCAMONGA CA
91730-4800
US

V. Phone/Fax

Practice location:
  • Phone: 909-945-0926
  • Fax:
Mailing address:
  • Phone: 909-945-0926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License NumberK4419
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: