Healthcare Provider Details

I. General information

NPI: 1003372699
Provider Name (Legal Business Name): EMILY VIZCARRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY VIZCARRA BCBA

II. Dates (important events)

Enumeration Date: 02/19/2019
Last Update Date: 12/15/2022
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 CANYON CREST DR
RIVERSIDE CA
92507-7721
US

IV. Provider business mailing address

225 NORTHSHORE DR
LAKE ELSINORE CA
92530-1816
US

V. Phone/Fax

Practice location:
  • Phone: 951-346-4860
  • Fax:
Mailing address:
  • Phone: 951-965-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-63153
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: