Healthcare Provider Details

I. General information

NPI: 1669573903
Provider Name (Legal Business Name): KAREN NMN ACCARDO-BAQUERO L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 01/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11858 BERNARDO PLAZA CT SUITE 210
SAN DIEGO CA
92128-2439
US

IV. Provider business mailing address

11858 BERNARDO PLAZA CT SUITE 210
SAN DIEGO CA
92128-2439
US

V. Phone/Fax

Practice location:
  • Phone: 760-505-1712
  • Fax: 858-592-1495
Mailing address:
  • Phone: 760-505-1712
  • Fax: 858-592-1495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCS 15116
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 15116
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: