Provider Demographics
NPI:1255802831
Name:ZUNIGA, BERLY JAVIER
Entity type:Individual
Prefix:
First Name:BERLY
Middle Name:JAVIER
Last Name:ZUNIGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22912 PENASCO CIR
Mailing Address - Street 2:
Mailing Address - City:NUEVO
Mailing Address - State:CA
Mailing Address - Zip Code:92567-8990
Mailing Address - Country:US
Mailing Address - Phone:951-660-3594
Mailing Address - Fax:
Practice Address - Street 1:13687 SUNRAY CT
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-6012
Practice Address - Country:US
Practice Address - Phone:951-660-3594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty