MEDICARE: JODY ANN VIZCAY

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
1	106H00000X	Marriage & Family Therapist	111292	CA

General Provider Information

NPI Number	:	1245557974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODY ANN VIZCAY

Provider Business Mailing Address
First Line	:	631 S BROOKHURST ST STE 104
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92804-3510
Country	:	US
Telephone Number	:	714-620-8131
Fax Number	:

Provider Business Practice Location Address
First Line	:	631 S BROOKHURST ST STE 104
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92804-3510
Country	:	US
Telephone Number	:	714-620-8131
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2010
Last Update Date	:	02/16/2024

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Directions to “ JODY ANN VIZCAY ” Practice Location

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