Healthcare Provider Details

I. General information

NPI: 1467152165
Provider Name (Legal Business Name): ALISON SUE LAZCANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALISON SUE BRIGNONI

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 BEACH BLVD STE 245
BUENA PARK CA
90621-4031
US

IV. Provider business mailing address

6301 BEACH BLVD STE 245
BUENA PARK CA
90621-4031
US

V. Phone/Fax

Practice location:
  • Phone: 714-736-0231
  • Fax: 714-736-0895
Mailing address:
  • Phone: 714-736-0231
  • Fax: 714-736-0895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number138050
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: