Healthcare Provider Details

I. General information

NPI: 1346165438
Provider Name (Legal Business Name): DESTINY VICTORIA STARKWEATHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 5TH AVE
UPLAND CA
91786-4839
US

IV. Provider business mailing address

10808 FOOTHILL BLVD STE 160
RANCHO CUCAMONGA CA
91730-0601
US

V. Phone/Fax

Practice location:
  • Phone: 909-495-0314
  • Fax:
Mailing address:
  • Phone: 909-495-0314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number164903
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: