Healthcare Provider Details

I. General information

NPI: 1053752006
Provider Name (Legal Business Name): JERRI A. BURNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2013
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5870 ARLINGTON AVE SUITE #103
RIVERSIDE CA
92504-2037
US

IV. Provider business mailing address

5870 ARLINGTON AVE SUITE #103
RIVERSIDE CA
92504-2037
US

V. Phone/Fax

Practice location:
  • Phone: 951-683-6596
  • Fax: 951-683-4239
Mailing address:
  • Phone: 951-683-6596
  • Fax: 951-683-4239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberACSW113226
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: