Healthcare Provider Details

I. General information

NPI: 1144038704
Provider Name (Legal Business Name): GISSELLE MARTINEZ VIZCAYA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2024
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70025 HIGHWAY 111 STE 102
RANCHO MIRAGE CA
92270-2935
US

IV. Provider business mailing address

70025 HIGHWAY 111 STE 102
RANCHO MIRAGE CA
92270-2935
US

V. Phone/Fax

Practice location:
  • Phone: 949-630-8290
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: