Healthcare Provider Details

I. General information

NPI: 1295505378
Provider Name (Legal Business Name): ADRIANA IVONNE ARTEAGA I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 UNIVERSAL CITY PLZ
UNIVERSAL CITY CA
91608-1002
US

IV. Provider business mailing address

11766 DOS PALMAS RD
VICTORVILLE CA
92392-0498
US

V. Phone/Fax

Practice location:
  • Phone: 909-891-1599
  • Fax:
Mailing address:
  • Phone: 760-490-9418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: