Healthcare Provider Details

I. General information

NPI: 1356267660
Provider Name (Legal Business Name): MARIELA BRISA SANCHEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 N MOUNTAIN AVE STE 109
UPLAND CA
91786-5714
US

IV. Provider business mailing address

1030 E PRINCETON ST
ONTARIO CA
91764-2514
US

V. Phone/Fax

Practice location:
  • Phone: 909-610-9151
  • Fax:
Mailing address:
  • Phone: 323-480-5190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number10301
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: