Healthcare Provider Details

I. General information

NPI: 1396668190
Provider Name (Legal Business Name): LIZETH BABUN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. LIZETH MARIA AUXILIADORA BABUN

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17270 BEAR VALLEY RD STE 105
VICTORVILLE CA
92395-7751
US

IV. Provider business mailing address

17270 BEAR VALLEY RD STE 105
VICTORVILLE CA
92395-7751
US

V. Phone/Fax

Practice location:
  • Phone: 760-245-8828
  • Fax:
Mailing address:
  • Phone: 714-914-2135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number7121
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: