Healthcare Provider Details

I. General information

NPI: 1326924648
Provider Name (Legal Business Name): DESIREE SPADARO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 08/13/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 N EUCLID AVE
UPLAND CA
91786-4763
US

IV. Provider business mailing address

805 ALLEN AVE
LA VERNE CA
91750-3202
US

V. Phone/Fax

Practice location:
  • Phone: 909-949-7804
  • Fax:
Mailing address:
  • Phone: 909-242-4246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC20077
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: