Healthcare Provider Details

I. General information

NPI: 1164377347
Provider Name (Legal Business Name): SAUL PICHARDO VIZCARRA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 03/03/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 S. ALVARADO
LOS ANGELES CA
90057
US

IV. Provider business mailing address

136 S WESTLAKE AV #3
LOS ANGELES CA
90057
US

V. Phone/Fax

Practice location:
  • Phone: 323-987-1034
  • Fax:
Mailing address:
  • Phone: 323-557-0850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: