MEDICARE: LIZZETTE VESCERA LMFT

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
1	106H00000X	Marriage & Family Therapist	87605	CA

General Provider Information

NPI Number	:	1063670586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIZZETTE VESCERA LMFT

Provider Business Mailing Address
First Line	:	4761 LAGUNITA WAY
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92057-1214
Country	:	US
Telephone Number	:	562-257-6528
Fax Number	:	866-506-5725

Provider Business Practice Location Address
First Line	:	2659 STATE ST STE 100
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92008-1627
Country	:	US
Telephone Number	:	562-257-6528
Fax Number	:	866-506-5725

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2008
Last Update Date	:	09/02/2021

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