1649220559 NPI number — MRS. RAQUEL BELEN PIZANO-HAZAMA LCSW

Table of content: MRS. RAQUEL BELEN PIZANO-HAZAMA LCSW (NPI 1649220559)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649220559 NPI number — MRS. RAQUEL BELEN PIZANO-HAZAMA LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PIZANO-HAZAMA
Provider First Name:
RAQUEL
Provider Middle Name:
BELEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PIZANO
Provider Other First Name:
RAQUEL
Provider Other Middle Name:
BELEN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649220559
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 553
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN GABRIEL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91778-0553
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-786-0341
Provider Business Mailing Address Fax Number:
626-398-6879

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
625 FAIR OAKS AVE
Provider Second Line Business Practice Location Address:
SUITE 374
Provider Business Practice Location Address City Name:
SOUTH PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91030-2630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-786-0341
Provider Business Practice Location Address Fax Number:
626-398-6879
Provider Enumeration Date:
05/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCS16131 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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