Healthcare Provider Details

I. General information

NPI: 1083289045
Provider Name (Legal Business Name): NATALIE ABIGAIL LIZARRAGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2021
Last Update Date: 05/22/2021
Certification Date: 05/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21600 OXNARD ST STE 1030
WOODLAND HILLS CA
91367-5085
US

IV. Provider business mailing address

13627 SHERMAN WAY APT 133
VAN NUYS CA
91405-2885
US

V. Phone/Fax

Practice location:
  • Phone: 877-206-1009
  • Fax:
Mailing address:
  • Phone: 818-821-9447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: