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General NPI Number Information
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NPI Number | 1902362205
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Entity Type | Individual
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Provider Name | JUANA ESTRELLA VIZCARRA ROCHA M.A
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Gender | Female
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Dates
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Enumeration Date | 02/12/2019
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Last Update Date | 02/19/2019
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Provider Practice Location Address
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Address Line | 1126 W FOOTHILL BLVD STE 150
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City | UPLAND
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State | CA
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Zip | 91786-3778
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Country | US
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Telephone | 909-296-6747
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Fax |
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Provider Business Mailing Address
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Address Line | 11875 PIGEON PASS RD SUITE B13 PMB #314
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City | MORENO VALLEY
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State | CA
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Zip | 92557
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Country | US
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Telephone |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1715
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 111740
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License Number State | CA
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