Provider Demographics
NPI:1083588677
Name:MCCULLOUGH, MARIA SANCHEZ
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:SANCHEZ
Last Name:MCCULLOUGH
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 W D ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-3026
Mailing Address - Country:US
Mailing Address - Phone:909-459-2500
Mailing Address - Fax:
Practice Address - Street 1:415 E G ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-3729
Practice Address - Country:US
Practice Address - Phone:909-983-8522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-06
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach