Provider Demographics
NPI:1588796569
Name:ISLAS, MARITZA
Entity Type:Individual
Prefix:
First Name:MARITZA
Middle Name:
Last Name:ISLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARITZA
Other - Middle Name:
Other - Last Name:PAEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:160 S 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91746-3211
Mailing Address - Country:US
Mailing Address - Phone:626-974-0770
Mailing Address - Fax:626-974-0774
Practice Address - Street 1:160 S 7TH AVE
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91746-3211
Practice Address - Country:US
Practice Address - Phone:626-974-0770
Practice Address - Fax:626-974-0774
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50898106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist