Provider Demographics
NPI:1427336924
Name:MARES, IMELDA (MASTERS IN SCIENCE)
Entity type:Individual
Prefix:MRS
First Name:IMELDA
Middle Name:
Last Name:MARES
Suffix:
Gender:F
Credentials:MASTERS IN SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 WEST SIXTH STREET SUITE 108
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762
Mailing Address - Country:US
Mailing Address - Phone:909-292-7826
Mailing Address - Fax:909-563-7235
Practice Address - Street 1:980 WEST SIXTH STREET SUITE 108
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762
Practice Address - Country:US
Practice Address - Phone:909-292-7826
Practice Address - Fax:909-563-7235
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-01
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103913106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist