MEDICARE: ROSA MARIA LIZARRAGA BA, MS, PPS, CWA

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	113959	CA

General Provider Information

NPI Number	:	1407987183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSA MARIA LIZARRAGA BA, MS, PPS, CWA

Provider Business Mailing Address
First Line	:	PO BOX 405
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91031-0405
Country	:	US
Telephone Number	:	626-657-8439
Fax Number	:

Provider Business Practice Location Address
First Line	:	446 S MARENGO AVE STE A
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-3113
Country	:	US
Telephone Number	:	626-657-8439
Fax Number	:

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

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	03/05/2024

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