Healthcare Provider Details

I. General information

NPI: 1073494647
Provider Name (Legal Business Name): CESARE FOGLIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2204 PACIFIC AVE N
LONG BEACH WA
98631-3300
US

IV. Provider business mailing address

2204 PACIFIC AVE N
LONG BEACH WA
98631-3300
US

V. Phone/Fax

Practice location:
  • Phone: 360-642-3787
  • Fax:
Mailing address:
  • Phone: 360-642-3787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCG70032221
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCG70032221
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: