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General NPI Number Information
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NPI Number | 1225528862
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Entity Type | Individual
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Provider Name | AHZULI MIREL ANSERMET ACSW
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Gender | Female
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Dates
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Enumeration Date | 05/17/2018
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 1585 S D ST
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3257
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Country | US
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Telephone | 909-332-2824
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Fax |
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Provider Business Mailing Address
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Address Line | 1542 E BROCKTON AVE
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City | REDLANDS
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State | CA
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Zip | 92374-3904
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Country | US
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Telephone | 909-499-5198
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 130239
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License Number State | CA
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