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NPI Code Detail

MEDICARE: MR. HENRY BURCIAGA MFT

MEDICARE: MR. HENRY BURCIAGA MFT
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
1106H00000XMarriage & Family TherapistMFC19940CA
2106H00000XMarriage & Family Therapist
3106H00000XMarriage & Family TherapistMFT19940CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1487785705
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. HENRY BURCIAGA MFT
Provider Business Mailing Address
First Line : 27555 E TRAIL RIDGE WAY APT 1094
Second Line :
City : MORENO VALLEY
State : CA
Zip : 92555-4491
Country : US
Telephone Number : 310-908-8379
Fax Number :
Provider Business Practice Location Address
First Line : 14700 MANZANITA RD
Second Line :
City : BEAUMONT
State : CA
Zip : 92223-3026
Country : US
Telephone Number : 951-845-3155
Fax Number : 951-845-8412
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2007
Last Update Date : 04/02/2018

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