Provider Demographics
NPI:1790401594
Name:KAZIMI, LIZA
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:
Last Name:KAZIMI
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 1:1800 MAXWELL RD
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-6158
Mailing Address - Country:US
Mailing Address - Phone:251-767-8735
Mailing Address - Fax:
Practice Address - Street 1:4027 VIA DE LA PAZ
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92057-7336
Practice Address - Country:US
Practice Address - Phone:251-767-8735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical