Healthcare Provider Details

I. General information

NPI: 1114043783
Provider Name (Legal Business Name): JANET URQUIZU LCS21386
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 03/13/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 FALLBROOK AVE CONFERENCE ROOM
WEST HILLS CA
91307-3530
US

IV. Provider business mailing address

6700 FALLBROOK AVE CONFERENCE ROOM
WEST HILLS CA
91307-3530
US

V. Phone/Fax

Practice location:
  • Phone: 818-744-2135
  • Fax: 818-713-1062
Mailing address:
  • Phone: 818-744-2135
  • Fax: 818-713-1062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY22763
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS21386
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: