MEDICARE: ROSA MARIA IZQUIERDO 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	101YM0800X	Mental Health Counselor	62720	CA
2	106H00000X	Marriage & Family Therapist	78618	CA

General Provider Information

NPI Number	:	1487953030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSA MARIA IZQUIERDO LMFT

Provider Business Mailing Address
First Line	:	PO BOX 3738
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92654-3738
Country	:	US
Telephone Number	:	949-303-3814
Fax Number	:

Provider Business Practice Location Address
First Line	:	26050 ACERO STE 320
Second Line	:
City	:	MISSION VIEJO
State	:	CA
Zip	:	92691-2768
Country	:	US
Telephone Number	:	949-303-3814
Fax Number	:	949-709-8949

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

Provider Enumeration Date	:	03/22/2011
Last Update Date	:	04/09/2018

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