Healthcare Provider Details

I. General information

NPI: 1366190548
Provider Name (Legal Business Name): ALEXANDRA MAAME YAA OWUSU ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2022
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N ARROWHEAD AVE
SAN BERNARDINO CA
92401-1164
US

IV. Provider business mailing address

600 N ARROWHEAD AVE
SAN BERNARDINO CA
92401-1164
US

V. Phone/Fax

Practice location:
  • Phone: 909-522-4656
  • Fax:
Mailing address:
  • Phone: 909-522-4656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW102713
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: