Healthcare Provider Details

I. General information

NPI: 1467583864
Provider Name (Legal Business Name): MRS. ZUELIKA CRISTINA XICOTENCATL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 09/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E GILBERT ST
SAN BERNARDINO CA
92415-1004
US

IV. Provider business mailing address

700 E GILBERT ST
SAN BERNARDINO CA
92415-1003
US

V. Phone/Fax

Practice location:
  • Phone: 909-387-6942
  • Fax: 909-386-0750
Mailing address:
  • Phone: 909-387-7378
  • Fax: 909-387-7386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: