Healthcare Provider Details

I. General information

NPI: 1861209769
Provider Name (Legal Business Name): MR. MARK JOSEPH VIZIOLI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2024
Last Update Date: 02/13/2026
Certification Date: 02/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5335 CRANER AVE
NORTH HOLLYWOOD CA
91601-3313
US

IV. Provider business mailing address

3514 GREENFIELD AVE
LOS ANGELES CA
90034-6102
US

V. Phone/Fax

Practice location:
  • Phone: 818-927-4045
  • Fax: 818-927-4016
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number18838
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number18838
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: