Healthcare Provider Details

I. General information

NPI: 1902671407
Provider Name (Legal Business Name): JOANNA VIZCAYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2023
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14139 BUCHER AVE
SYLMAR CA
91342-1442
US

IV. Provider business mailing address

14139 BUCHER AVE
SYLMAR CA
91342-1442
US

V. Phone/Fax

Practice location:
  • Phone: 818-290-5309
  • Fax:
Mailing address:
  • Phone: 818-290-5309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number141583
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: