Healthcare Provider Details

I. General information

NPI: 1134715428
Provider Name (Legal Business Name): RICARDO CAZAREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2020
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7038 OWENSMOUTH AVE
CANOGA PARK CA
91303-3198
US

IV. Provider business mailing address

7038 OWENSMOUTH AVE
CANOGA PARK CA
91303-3198
US

V. Phone/Fax

Practice location:
  • Phone: 818-347-8565
  • Fax: 818-347-0506
Mailing address:
  • Phone: 818-347-8565
  • Fax: 818-347-0506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: