Healthcare Provider Details

I. General information

NPI: 1104186774
Provider Name (Legal Business Name): JOSEPHINE CRUZ BURNIAS MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2012
Last Update Date: 05/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 E PINE ST
EXETER CA
93221-1750
US

IV. Provider business mailing address

PO BOX 1333
TULARE CA
93275-1333
US

V. Phone/Fax

Practice location:
  • Phone: 559-901-7820
  • Fax: 559-688-6103
Mailing address:
  • Phone: 559-901-7820
  • Fax: 559-688-6103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number27560
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: