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General NPI Number Information
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NPI Number | 1235387994
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Entity Type | Individual
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Provider Name | MRS. LYDIANA GARCIA-SUAZO
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Gender | Female
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Dates
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Enumeration Date | 09/05/2008
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Last Update Date | 06/14/2023
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Provider Practice Location Address
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Address Line | 3031 N SAN FERNANDO BLVD STE 100
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City | BURBANK
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State | CA
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Zip | 91504-4704
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Country | US
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Telephone | 310-592-5333
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Fax |
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Provider Business Mailing Address
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Address Line | 30825 PENNY SURF LOOP
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City | WESLEY CHAPEL
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State | FL
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Zip | 33545-2306
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Country | US
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Telephone | 310-592-3333
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY11720
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 3838
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License Number State | PR
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Taxonomy #3
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PSY24888
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY24888
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License Number State | CA
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