Healthcare Provider Details

I. General information

NPI: 1598856015
Provider Name (Legal Business Name): JONEL MIZERAK LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JONEL MIZERAK PHYSICAL THERAPIST A

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 GREGORY LN SUITE 46
PLEASANT HILL CA
94523-4982
US

IV. Provider business mailing address

101 GREGORY LN SUITE 46
PLEASANT HILL CA
94523-4982
US

V. Phone/Fax

Practice location:
  • Phone: 925-548-8841
  • Fax: 925-548-8841
Mailing address:
  • Phone: 925-548-8841
  • Fax: 925-548-8841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberAT259
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC48118
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: