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NPI Code Detail

MEDICARE: DELICACIES OF THE HEART

MEDICARE: DELICACIES OF THE HEART
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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1508499807
Entity Type Code : Organization
Provider Name (Legal Business Name) : DELICACIES OF THE HEART
Provider Business Mailing Address
First Line : PO BOX 3502
Second Line :
City : RANCHO CUCAMONGA
State : CA
Zip : 91729-3502
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3350 SHELBY ST STE 200
Second Line :
City : ONTARIO
State : CA
Zip : 91764-5556
Country : US
Telephone Number : 909-278-9096
Fax Number :
Authorized Official
Title or Position : CEO/CHRISTIAN AND SEX THERAPIST
Name : CHRISTINA BURDEN
Credential : LCSW
Telephone Number : 909-549-1347
Provider Enumeration Date : 02/15/2020
Last Update Date : 02/15/2020

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Directions to “DELICACIES OF THE HEART ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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