Healthcare Provider Details

I. General information

NPI: 1831438613
Provider Name (Legal Business Name): LISA KOZLOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2013
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2813 S MAIN ST
CORONA CA
92882-5942
US

IV. Provider business mailing address

1240 E ONTARIO AVE STE 102-148
CORONA CA
92881-8671
US

V. Phone/Fax

Practice location:
  • Phone: 951-737-2962
  • Fax:
Mailing address:
  • Phone: 714-315-8101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number119672
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: