Healthcare Provider Details

I. General information

NPI: 1972076529
Provider Name (Legal Business Name): FATIMA ALRAZAA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41945 BIG BEAR BLVD # 222
BIG BEAR LAKE CA
92315-2030
US

IV. Provider business mailing address

PO BOX 1523
BIG BEAR LAKE CA
92315-1523
US

V. Phone/Fax

Practice location:
  • Phone: 909-866-5070
  • Fax:
Mailing address:
  • Phone: 909-242-5324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC11706.
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: