Healthcare Provider Details

I. General information

NPI: 1497670624
Provider Name (Legal Business Name): IMAGINE WELLNESS HEALTH GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 NEVADA ST STE B
REDLANDS CA
92373-4222
US

IV. Provider business mailing address

12 NEVADA ST STE B
REDLANDS CA
92373-4222
US

V. Phone/Fax

Practice location:
  • Phone: 909-894-8084
  • Fax:
Mailing address:
  • Phone: 909-894-8084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: DR. PATRICIA ANN FORD
Title or Position: CEO
Credential: DRPH, MPH CEDRD
Phone: 909-894-8084