Healthcare Provider Details

I. General information

NPI: 1043037674
Provider Name (Legal Business Name): REGINALD MARC ZAPANTA DIONISIO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 S E ST
SAN BERNARDINO CA
92408-2773
US

IV. Provider business mailing address

290 N D ST
SAN BERNARDINO CA
92401-1734
US

V. Phone/Fax

Practice location:
  • Phone: 909-388-9191
  • Fax:
Mailing address:
  • Phone: 909-963-5355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number159710
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: