Provider Demographics
NPI:1245557974
Name:VIZCAY, JODY ANN
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:ANN
Last Name:VIZCAY
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 1:631 S BROOKHURST ST STE 104
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-3510
Mailing Address - Country:US
Mailing Address - Phone:714-620-8131
Mailing Address - Fax:
Practice Address - Street 1:631 S BROOKHURST ST STE 104
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3510
Practice Address - Country:US
Practice Address - Phone:714-620-8131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111292106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist