Healthcare Provider Details

I. General information

NPI: 1609387604
Provider Name (Legal Business Name): KIMBERLY SUE BURCIAGA CADCI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY SUE BURCIAGA CADCI-CICA02730220

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5772 GARDEN GROVE BLVD SPC 255
WESTMINSTER CA
92683-1822
US

IV. Provider business mailing address

5772 GARDEN GROVE BLVD SPC 255
WESTMINSTER CA
92683-1822
US

V. Phone/Fax

Practice location:
  • Phone: 714-984-3187
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCICA02730220
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: