Individual provider Active NPI

Dea Shavonni Ralph

  • Social Worker
  • San Bernardino, CA
National Provider Identifier
1558061382
Registry record updated Oct 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
111790 Issued in CA
Practice address
290 N D St Ste 700
San Bernardino, CA 92401-1705
Phone
(909) 963-5355
NPI assigned
Mar 9, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 27, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 111790 CA Primary

Addresses

Primary practice location

290 N D St Ste 700
San Bernardino, CA 92401-1705

Mailing address

290 N D St Ste 700
San Bernardino, CA 92401-1705
Phone (909) 963-5355

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
111790CAMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Step Up on Second Street Inc. CurrentSince Mar 1, 2023 Accepting new patients
Victor Community Support Services, Inc. PastSince Sep 1, 2023 Accepting new patients

Locations

600 N Arrowhead Ave
San Bernardino, CA 92401
Phone (909) 522-4656

290 N D St
Ste 700
San Bernardino, CA 92401
Phone (909) 963-5355

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1678320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761523200000",
    "number": "1558061382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "290 N D ST STE 700",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924011705",
            "telephone_number": "909-963-5355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "290 N D ST STE 700",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924011705",
            "telephone_number": "909-963-5355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RALPH",
        "first_name": "DEA",
        "middle_name": "SHAVONNI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-03-09",
        "last_updated": "2025-10-27",
        "certification_date": "2025-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CA",
            "license": "111790",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Bernardino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.