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General NPI Number Information
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NPI Number | 1427407089
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Entity Type | Individual
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Provider Name | BRIANNA VIZCARRA LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/05/2016
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 5500 CAMPANILE DR SAN DIEGO CA 92182
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City | SAN DIEGO
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State | CA
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Zip | 92182
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Country | US
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Telephone | 619-405-4090
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Fax |
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Provider Business Mailing Address
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Address Line | 13223 BLACK MOUNTAIN RD. STE 1 PMB 1004
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City | SAN DIEGO
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State | CA
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Zip | 92129
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Country | US
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Telephone | 619-405-4090
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 117582
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License Number State | CA
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