Healthcare Provider Details

I. General information

NPI: 1548578115
Provider Name (Legal Business Name): XIOMARA G MORENO-KRONCKE MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 09/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

684 ELLIS ST
SAN FRANCISCO CA
94109-8090
US

IV. Provider business mailing address

684 ELLIS ST
SAN FRANCISCO CA
94109-8090
US

V. Phone/Fax

Practice location:
  • Phone: 415-409-4611
  • Fax: 415-409-4617
Mailing address:
  • Phone: 415-409-4611
  • Fax: 415-409-4617

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: