Healthcare Provider Details

I. General information

NPI: 1407988033
Provider Name (Legal Business Name): PATRICIA R VIZCARRA MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 E WASHINGTON BLVD STE A
LOS ANGELES CA
90021-3082
US

IV. Provider business mailing address

2801 S SAN PEDRO ST
LOS ANGELES CA
90011-2023
US

V. Phone/Fax

Practice location:
  • Phone: 323-233-3100
  • Fax: 323-233-4100
Mailing address:
  • Phone: 323-233-3100
  • Fax: 323-233-4100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: