Healthcare Provider Details

I. General information

NPI: 1033042684
Provider Name (Legal Business Name): ALIZA VAYNGURT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2147 LINDALE AVE
SIMI VALLEY CA
93065-2721
US

IV. Provider business mailing address

2147 LINDALE AVE
SIMI VALLEY CA
93065-2721
US

V. Phone/Fax

Practice location:
  • Phone: 818-448-8810
  • Fax:
Mailing address:
  • Phone: 818-448-8810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberA064700724
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA064700724
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberA064700724
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: