Healthcare Provider Details

I. General information

NPI: 1528982436
Provider Name (Legal Business Name): ISMELIS POZO ECHEVARRIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10391 CORPORATE DR
REDLANDS CA
92374-4509
US

IV. Provider business mailing address

6949 JASMINE CT
SAN BERNARDINO CA
92407-1929
US

V. Phone/Fax

Practice location:
  • Phone: 909-583-6765
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number95215706
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: