Provider Demographics
NPI:1407987183
Name:LIZARRAGA, ROSA MARIA (BA, MS, PPS, CWA)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:MARIA
Last Name:LIZARRAGA
Suffix:
Gender:F
Credentials:BA, MS, PPS, CWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 405
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91031-0405
Mailing Address - Country:US
Mailing Address - Phone:626-657-8439
Mailing Address - Fax:
Practice Address - Street 1:446 S MARENGO AVE STE A
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-3113
Practice Address - Country:US
Practice Address - Phone:626-657-8439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA113959106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist