Healthcare Provider Details

I. General information

NPI: 1164634242
Provider Name (Legal Business Name): FOOTSTEPS INTO HEALTH, INC,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

268 MCARTHUR WAY
UPLAND CA
91786
US

IV. Provider business mailing address

268 MCARTHUR WAY
UPLAND CA
91786
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. BYRON GIO CORZO
Title or Position: PROGRAM DIRECTOR
Credential: MBA
Phone: 909-920-1165