Healthcare Provider Details

I. General information

NPI: 1326640822
Provider Name (Legal Business Name): LASTARR DAILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11801 PIERCE ST STE 200
RIVERSIDE CA
92505-4400
US

IV. Provider business mailing address

1500 S HAVEN AVE STE 250
ONTARIO CA
91761-2973
US

V. Phone/Fax

Practice location:
  • Phone: 714-267-9310
  • Fax:
Mailing address:
  • Phone: 909-749-5204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: