Basic Information
| Provider Information | |||||||||
| NPI: | 1255854980 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ARTEAGA | ||||||||
| FirstName: | EVA | ||||||||
| MiddleName: | GRICELDA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 751 | ||||||||
| Address2: | |||||||||
| City: | FONTANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923340751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9096009770 | ||||||||
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| Practice Location | |||||||||
| Address1: | 17800 US HIGHWAY 18 | ||||||||
| Address2: | |||||||||
| City: | APPLE VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923071221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7605526700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2017 | ||||||||
| LastUpdateDate: | 04/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 83985 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.