Healthcare Provider Details

I. General information

NPI: 1407513633
Provider Name (Legal Business Name): VALLEY PSYCHIATRIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2021
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 NEW JERSEY ST STE A
REDLANDS CA
92373-6249
US

IV. Provider business mailing address

PO BOX 1303
LOMA LINDA CA
92354-1303
US

V. Phone/Fax

Practice location:
  • Phone: 909-792-6886
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. LIBERTY MACIAS
Title or Position: CEO
Credential: DNP
Phone: 909-792-6886