Healthcare Provider Details

I. General information

NPI: 1750215034
Provider Name (Legal Business Name): NEURODIVERSE FITNESS AND MOVEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1995 SHADY BROOK WAY
UPLAND CA
91784-7430
US

IV. Provider business mailing address

1995 SHADY BROOK WAY
UPLAND CA
91784-7430
US

V. Phone/Fax

Practice location:
  • Phone: 909-994-4351
  • Fax:
Mailing address:
  • Phone: 909-994-4351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ROSALIA MARIE SCHMIDT
Title or Position: DIRECTOR
Credential:
Phone: 909-994-4351