MEDICARE: LANESHA RAQUEL ZIEGLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	93825	CA

General Provider Information

NPI Number	:	1063180685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANESHA RAQUEL ZIEGLER

Provider Business Mailing Address
First Line	:	11755 MALAGA DR UNIT 1060
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91730-8124
Country	:	US
Telephone Number	:	424-348-9921
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 W 4TH ST
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92415-4194
Country	:	US
Telephone Number	:	909-382-7881
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2021
Last Update Date	:	10/27/2023

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