Individual
DEA SHAVONNI RALPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
290 N D ST STE 700, SAN BERNARDINO, CA 92401-1705
(909) 963-5355
Mailing address
290 N D ST STE 700, SAN BERNARDINO, CA 92401-1705
(909) 963-5355
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
111790
CA
Other
Enumeration date
03/09/2023
Last updated
10/27/2025
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