Provider Demographics
NPI:1750176095
Name:CIOCO, IRESHA LINDA (PMHNP)
Entity type:Individual
Prefix:
First Name:IRESHA
Middle Name:LINDA
Last Name:CIOCO
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15106 FOX RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-0205
Mailing Address - Country:US
Mailing Address - Phone:650-703-3000
Mailing Address - Fax:
Practice Address - Street 1:15106 FOX RIDGE DR
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-0205
Practice Address - Country:US
Practice Address - Phone:650-703-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA950340162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty