Healthcare Provider Details

I. General information

NPI: 1346364452
Provider Name (Legal Business Name): GLENDA LIZARDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17909 SOLEDAD CANYON RD FL 2
SANTA CLARITA CA
91387-3210
US

IV. Provider business mailing address

17909 SOLEDAD CANYON RD FL 2
SANTA CLARITA CA
91387-3210
US

V. Phone/Fax

Practice location:
  • Phone: 661-673-8888
  • Fax:
Mailing address:
  • Phone: 661-673-8888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW142607
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: