Provider Demographics
NPI:1003047887
Name:BRIZUELA, CARLA DIANE
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:DIANE
Last Name:BRIZUELA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16205 SIERRA PASS WAY
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-6533
Mailing Address - Country:US
Mailing Address - Phone:818-445-7439
Mailing Address - Fax:
Practice Address - Street 1:13001 RAMONA BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:IRWINDALE
Practice Address - State:CA
Practice Address - Zip Code:91706-3752
Practice Address - Country:US
Practice Address - Phone:626-373-2900
Practice Address - Fax:626-373-2940
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker