NPIMap

Organization Active NPI

Realitos Divison

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • La Verne, CA
National Provider Identifier
1912159385
Registry record updated Jun 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
License
960000953 Issued in CA
Legal business name
REALITOS DIVISON
Practice address
612 Realitos Dr
La Verne, CA 91750-2844
Phone
(909) 899-5046
Fax
(909) 463-2005
NPI assigned
Oct 16, 2008
Organization subpart
Yes
Parent organization
MONTE VISTA CHILD CARE CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 18, 2025

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

Authorized official

Name
Miss Deisy Odett Mendoza
Title
Executive Director
Phone
(909) 912-9314

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X 960000953 CA Primary

Addresses

Primary practice location

612 Realitos Dr
La Verne, CA 91750-2844

Mailing address

13342 Victoria St
Rancho Cucamonga, CA 91739-2020
Phone (909) 899-5046

National Provider Directory

National Provider Directory
Tax ID family
Victoria Division19 organizations share this tax ID, including this one
Part of
Victoria Division

Other organizations with this tax ID 18

Organizations that report the same tax identification number in the National Provider Directory.

View all 18

Locations

9140 Monte Vis Ave
Montclair, CA 91763
Phone 6262566010308

NPI Registry JSON

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

{
    "created_epoch": "1224115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750204800000",
    "number": "1912159385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13342 VICTORIA ST",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917392020",
            "telephone_number": "909-899-5046",
            "fax_number": "909-463-2005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 REALITOS DR",
            "city": "LA VERNE",
            "state": "CA",
            "postal_code": "917502844",
            "telephone_number": "909-899-5046",
            "fax_number": "909-463-2005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REALITOS DIVISON",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MONTE VISTA CHILD CARE CENTER",
        "enumeration_date": "2008-10-16",
        "last_updated": "2025-06-18",
        "certification_date": "2025-06-18",
        "status": "A",
        "authorized_official_last_name": "MENDOZA",
        "authorized_official_first_name": "DEISY",
        "authorized_official_middle_name": "ODETT",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "909-912-9314",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "CA",
            "license": "960000953",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Verne, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 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.