Healthcare Provider Details

I. General information

NPI: 1790614345
Provider Name (Legal Business Name): MARISELDA HAZELWOOD M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2975 E ALPINE AVE
TULARE CA
93274-4265
US

IV. Provider business mailing address

2409 KAISER CREEK AVE
TULARE CA
93274-7492
US

V. Phone/Fax

Practice location:
  • Phone: 559-687-3135
  • Fax:
Mailing address:
  • Phone: 559-972-6791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14565
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: