Healthcare Provider Details

I. General information

NPI: 1659035780
Provider Name (Legal Business Name): DELFA LIZAMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 01/09/2022
Certification Date: 01/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S FREMONT AVE UNIT 20
ALHAMBRA CA
91803-8840
US

IV. Provider business mailing address

1000 S FREMONT AVE UNIT 20. BUILDING A10. SUITE 10300
ALHAMBRA CA
91803
US

V. Phone/Fax

Practice location:
  • Phone: 626-759-9154
  • Fax:
Mailing address:
  • Phone: 626-759-9154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: