Healthcare Provider Details

I. General information

NPI: 1417639865
Provider Name (Legal Business Name): DESIREE MONIQUE SANCHEZ-MAGANA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2023
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N ARROWHEAD AVE
SAN BERNARDINO CA
92401-1164
US

IV. Provider business mailing address

600 N ARROWHEAD AVE
SAN BERNARDINO CA
92401-1164
US

V. Phone/Fax

Practice location:
  • Phone: 909-963-5355
  • Fax:
Mailing address:
  • Phone: 909-963-5355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number116664
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number116664
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: