Healthcare Provider Details

I. General information

NPI: 1942835590
Provider Name (Legal Business Name): LIZETH MONTSERRAT HERRERAWATKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2020
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 919
FULLERTON CA
92836-0919
US

IV. Provider business mailing address

PO BOX 919
FULLERTON CA
92836-0919
US

V. Phone/Fax

Practice location:
  • Phone: 714-680-9000
  • Fax: 714-680-8233
Mailing address:
  • Phone: 714-680-9000
  • Fax: 714-680-8233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC22867
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: