Healthcare Provider Details

I. General information

NPI: 1861381212
Provider Name (Legal Business Name): STACY DANIELLE CONTRERAS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

268 MCARTHUR WAY
UPLAND CA
91786-5615
US

IV. Provider business mailing address

268 MCARTHUR WAY
UPLAND CA
91786-5615
US

V. Phone/Fax

Practice location:
  • Phone: 909-920-1165
  • Fax: 909-949-3800
Mailing address:
  • Phone: 909-920-1165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95050289
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: