Healthcare Provider Details

I. General information

NPI: 1295689164
Provider Name (Legal Business Name): GEORGE VIZCARRA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2026
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 S INDIAN HILL BLVD
CLAREMONT CA
91711-5444
US

IV. Provider business mailing address

13247 FOOTHILL BLVD APT 12202
RANCHO CUCAMONGA CA
91739-9479
US

V. Phone/Fax

Practice location:
  • Phone: 909-942-9819
  • Fax:
Mailing address:
  • Phone: 909-476-2023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: