Healthcare Provider Details

I. General information

NPI: 1902700248
Provider Name (Legal Business Name): TRACY DAWN CAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 EVERRON CT
REDLANDS CA
92374-6375
US

IV. Provider business mailing address

1051 EVERRON CT
REDLANDS CA
92374-6375
US

V. Phone/Fax

Practice location:
  • Phone: 909-654-6798
  • Fax: 909-385-3348
Mailing address:
  • Phone: 909-654-6798
  • Fax: 909-385-3348

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: