Provider Demographics
NPI:1568061703
Name:FEMATT BRIZUELA, EDITH
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:
Last Name:FEMATT 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 1:1982 KENT ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-2703
Mailing Address - Country:US
Mailing Address - Phone:619-519-8980
Mailing Address - Fax:
Practice Address - Street 1:1424 30TH ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-3421
Practice Address - Country:US
Practice Address - Phone:619-565-2650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8836101YP2500X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional