Healthcare Provider Details

I. General information

NPI: 1205773009
Provider Name (Legal Business Name): MARIZA HERROZ MASTER OF ARTS & ED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 LEWIS AVE
SAN ANDRES CA
95249-0067
US

IV. Provider business mailing address

1721 THOMAS TAYLOR DR
HUGHSON CA
95326-8909
US

V. Phone/Fax

Practice location:
  • Phone: 209-542-0219
  • Fax:
Mailing address:
  • Phone: 209-542-0219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: