Healthcare Provider Details

I. General information

NPI: 1619008224
Provider Name (Legal Business Name): AMY JANE ZUEL R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 E GILBERT ST
SAN BERNARDINO CA
92415-0002
US

IV. Provider business mailing address

5994 HUDSON AVE
SAN BERNARDINO CA
92404-3520
US

V. Phone/Fax

Practice location:
  • Phone: 909-387-7200
  • Fax:
Mailing address:
  • Phone: 909-862-0524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number364063
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: