Provider Demographics
NPI:1609387604
Name:BURCIAGA, KIMBERLY SUE (CADCI)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SUE
Last Name:BURCIAGA
Suffix:
Gender:F
Credentials:CADCI
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:SUE
Other - Last Name:BURCIAGA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CADCI-CICA02730220
Mailing Address - Street 1:2531 W WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-2637
Mailing Address - Country:US
Mailing Address - Phone:714-266-9888
Mailing Address - Fax:
Practice Address - Street 1:2531 W WOODLAND DR
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2637
Practice Address - Country:US
Practice Address - Phone:714-266-9888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-17
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
CACICA02730220101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1609387604Medicaid
CACICA02730220Medicaid