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NPI Code Detail

MEDICARE: STACY DOWNS COLAIZZO MA

MEDICARE: STACY DOWNS COLAIZZO MA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMFC97281CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1578368OTHERMHN

General Provider Information

NPI Number : 1083141428
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACY DOWNS COLAIZZO MA
Provider Business Mailing Address
First Line : 28081 MARGUERITE PKWY # 2543
Second Line :
City : MISSION VIEJO
State : CA
Zip : 92690-1800
Country : US
Telephone Number : 949-478-2292
Fax Number :
Provider Business Practice Location Address
First Line : 21515 HAWTHORNE BLVD STE 200
Second Line :
City : TORRANCE
State : CA
Zip : 90503-6512
Country : US
Telephone Number : 949-478-2292
Fax Number : 949-478-2292
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2017
Last Update Date : 07/21/2022

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Directions to “ STACY DOWNS COLAIZZO MA” Practice Location

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