Individual
JESSICA LARA DE SANTIAGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
16465 SIERRA LAKES PKWY STE 140, FONTANA, CA 92336-1242
(909) 244-9593
(833) 903-0337
Mailing address
PO BOX 1388, CHINO HILLS, CA 91709-0047
(909) 573-3150
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
CA
225C00000X
Rehabilitation Counselor
—
—
Other
Enumeration date
09/20/2013
Last updated
05/07/2024
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