Healthcare Provider Details

I. General information

NPI: 1982868675
Provider Name (Legal Business Name): MRS. GENET G GEBREMARIAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2008
Last Update Date: 08/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 S D ST
SAN BERNARDINO CA
92408-3257
US

IV. Provider business mailing address

1186 BENT RAIL CIR
COLTON CA
92324-6225
US

V. Phone/Fax

Practice location:
  • Phone: 909-388-2222
  • Fax:
Mailing address:
  • Phone: 909-264-0418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: