Healthcare Provider Details

I. General information

NPI: 1396488409
Provider Name (Legal Business Name): CEZENA ISABEL FLEMING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CEZENA ISABEL AMEERIAR

II. Dates (important events)

Enumeration Date: 04/16/2022
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12625 HESPERIA RD
VICTORVILLE CA
92395-7720
US

IV. Provider business mailing address

12625 HESPERIA RD
VICTORVILLE CA
92395-7720
US

V. Phone/Fax

Practice location:
  • Phone: 760-995-8300
  • Fax:
Mailing address:
  • Phone: 760-995-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberAMFT144802
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT144802
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: