Search › California › 1041C0700X
Mariela Licon, LCSW
NPI 1497201602 · on the registry since 2016
Practice
- Address
- 1500 N Waterman Ave
San Bernardino, CA 92404 - Phone
- (909) 703-4099
- Organisation at this address
- Allan G Kavalich Md Inc
St. Johns Community Health
St. John'S Community Health
Bio-Medical Applications Of California, Inc.
Rai Care Centers Of Southern California I, LlcInferred from a shared address, not stated in the registry. - Clinicians at this address
- 5
Additional practice sites
- 10000 County Farm Rd, Riverside, CA
Registry record
- Primary taxonomy
- 1041C0700X
1041C0700X
- Also registered as
- 1041C0700X
- Licence states on file
- CA
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2025-09-11
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in California