Provider Demographics
NPI:1790079598
Name:PLASCENCIA, MARITZA (MA)
Entity Type:Individual
Prefix:MS
First Name:MARITZA
Middle Name:
Last Name:PLASCENCIA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19712 MACARTHUR BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2407
Mailing Address - Country:US
Mailing Address - Phone:949-243-0624
Mailing Address - Fax:
Practice Address - Street 1:17291 IRVINE BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2941
Practice Address - Country:US
Practice Address - Phone:949-331-4703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA91210106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist