Healthcare Provider Details

I. General information

NPI: 1053520668
Provider Name (Legal Business Name): CINDY SUE ALLEN CATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 E FOOTHILL BLVD
RIALTO CA
92376-5230
US

IV. Provider business mailing address

850 E FOOTHILL BLVD
RIALTO CA
92376-5230
US

V. Phone/Fax

Practice location:
  • Phone: 909-421-9495
  • Fax: 909-421-9494
Mailing address:
  • Phone: 909-421-9495
  • Fax: 909-421-9494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number061271
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: