Healthcare Provider Details

I. General information

NPI: 1639451677
Provider Name (Legal Business Name): BELINDA MARISCAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2011
Last Update Date: 05/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 W AVENUE J
LANCASTER CA
93534-3443
US

IV. Provider business mailing address

14745 DRELL ST
SYLMAR CA
91342-2121
US

V. Phone/Fax

Practice location:
  • Phone: 661-949-0131
  • Fax:
Mailing address:
  • Phone: 818-364-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: