Provider Demographics
NPI:1760744502
Name:VIZCARRA, ERIC JOSEPH
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:JOSEPH
Last Name:VIZCARRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 WILLOW PASS RD
Mailing Address - Street 2:APT 104
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94519-1055
Mailing Address - Country:US
Mailing Address - Phone:925-262-6551
Mailing Address - Fax:925-777-9933
Practice Address - Street 1:1413 F ST
Practice Address - Street 2:PORTABLE 1
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-2220
Practice Address - Country:US
Practice Address - Phone:925-777-1133
Practice Address - Fax:925-777-9933
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor