Provider Demographics
NPI:1184804940
Name:WISE, LUZ MARINA (LMFT)
Entity type:Individual
Prefix:
First Name:LUZ
Middle Name:MARINA
Last Name:WISE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15338 CENTRAL AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-7658
Mailing Address - Country:US
Mailing Address - Phone:559-424-3915
Mailing Address - Fax:909-614-7902
Practice Address - Street 1:15338 CENTRAL AVE STE 103
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-7658
Practice Address - Country:US
Practice Address - Phone:559-424-3915
Practice Address - Fax:909-614-7902
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist