Provider Demographics
NPI:1992857098
Name:LIZARRAGA, GLORIA (MFT)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:LIZARRAGA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14261 DANIELSON ST STE B
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-8897
Mailing Address - Country:US
Mailing Address - Phone:858-513-1001
Mailing Address - Fax:858-513-1011
Practice Address - Street 1:14261 DANIELSON ST STE B
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-8897
Practice Address - Country:US
Practice Address - Phone:858-513-1001
Practice Address - Fax:858-513-1011
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42816106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist