Healthcare Provider Details

I. General information

NPI: 1861934275
Provider Name (Legal Business Name): MIKAELA ZUNIGA DSW, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2016
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date: 01/22/2025
Reactivation Date: 02/12/2025

III. Provider practice location address

14515 WOODLAND DR UNIT 13
FONTANA CA
92337-0102
US

IV. Provider business mailing address

14515 WOODLAND DR UNIT 13
FONTANA CA
92337-0102
US

V. Phone/Fax

Practice location:
  • Phone: 909-437-4627
  • Fax:
Mailing address:
  • Phone: 909-437-4627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number117931
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: