Healthcare Provider Details

I. General information

NPI: 1588332456
Provider Name (Legal Business Name): MRS. MARIZ BEBAWY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2021
Last Update Date: 09/03/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23181 LA CADENA DR STE 103
LAGUNA HILLS CA
92653-1479
US

IV. Provider business mailing address

23181 LA CADENA DR STE 103
LAGUNA HILLS CA
92653-1479
US

V. Phone/Fax

Practice location:
  • Phone: 714-406-4399
  • Fax:
Mailing address:
  • Phone: 714-406-4399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number121431
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: