Provider Demographics
NPI:1710647219
Name:HORTA, LIZETTE
Entity Type:Individual
Prefix:MISS
First Name:LIZETTE
Middle Name:
Last Name:HORTA
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 1:1209 BATTLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-1674
Mailing Address - Country:US
Mailing Address - Phone:619-874-5720
Mailing Address - Fax:
Practice Address - Street 1:2005 EYE ST STE 8
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-4479
Practice Address - Country:US
Practice Address - Phone:559-679-5336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-20-44496103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty