1306713227 NPI number — HEALTH EMPOWERMENT THROUGH ACTIVE LEADERSHIP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306713227 NPI number — HEALTH EMPOWERMENT THROUGH ACTIVE LEADERSHIP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH EMPOWERMENT THROUGH ACTIVE LEADERSHIP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306713227
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1013 SUNBROOK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN BERNARDINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92407-5357
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5250 UNIVERSITY PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN BERNARDINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92407-7051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-310-2013
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2025

Additional Information

Authorized Official

Authorized Official Last Name:
GRAJEDA
Authorized Official First Name:
MARIAH
Authorized Official Middle Name:
Y
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
951-805-9856

Provider Taxonomy Codes

  • Taxonomy code: 172V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com