Healthcare Provider Details

I. General information

NPI: 1346381514
Provider Name (Legal Business Name): MISS ADACHI AMY MGBAFILIKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 08/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

572 N ARROWHEAD AVE STE 100
SAN BERNARDINO CA
92401-1217
US

IV. Provider business mailing address

572 N ARROWHEAD AVE STE 100
SAN BERNARDINO CA
92401-1217
US

V. Phone/Fax

Practice location:
  • Phone: 909-266-2000
  • Fax: 909-266-2710
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: