Basic Information
| Provider Information | |||||||||
| NPI: | 1801136411 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PARRAGA | ||||||||
| FirstName: | AN-TONIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7711 | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925137711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9514279992 | ||||||||
| FaxNumber: | 9512476959 | ||||||||
| Practice Location | |||||||||
| Address1: | 12810 HEACOCK ST STE B202 | ||||||||
| Address2: | |||||||||
| City: | MORENO VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925532873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9512476542 | ||||||||
| FaxNumber: | 9512476959 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2013 | ||||||||
| LastUpdateDate: | 04/25/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 87071 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.