Provider Demographics
NPI:1831679604
Name:STCLAIR, DULCE
Entity Type:Individual
Prefix:
First Name:DULCE
Middle Name:
Last Name:STCLAIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DULCE
Other - Middle Name:
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6228 PEAR AVE
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-8914
Mailing Address - Country:US
Mailing Address - Phone:323-633-4280
Mailing Address - Fax:
Practice Address - Street 1:1307 W 6TH ST STE 121
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-1642
Practice Address - Country:US
Practice Address - Phone:951-523-0221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty