Provider Demographics
NPI:1255828224
Name:TUASON, LIEZL TANEGA
Entity type:Individual
Prefix:
First Name:LIEZL
Middle Name:TANEGA
Last Name:TUASON
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 1:8689 CALLE DEL PRADO
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-1121
Mailing Address - Country:US
Mailing Address - Phone:626-858-4920
Mailing Address - Fax:626-858-4923
Practice Address - Street 1:8689 CALLE DEL PRADO
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-1121
Practice Address - Country:US
Practice Address - Phone:626-858-4920
Practice Address - Fax:626-858-4923
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1294250318101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR1294140318OtherCCAPP