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General NPI Number Information
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NPI Number | 1285240911
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Entity Type | Organization
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Legal Business Name | BUSINESS CENTER OF SAKURA
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Dates
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Enumeration Date | 09/18/2020
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Last Update Date | 03/19/2021
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Provider Practice Location Address
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Address Line | 14050 CHERRY AVE STE R-1077
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City | FONTANA
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State | CA
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Zip | 92337-0766
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Country | US
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Telephone | 909-279-2721
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Fax |
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Provider Business Mailing Address
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Address Line | 14050 CHERRY AVE STE R1077
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City | FONTANA
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State | CA
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Zip | 92337-0766
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | GABRIEL ANTHONY REYES
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Credential |
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Telephone | 909-521-0240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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