Provider Demographics
NPI:1265062863
Name:FIRTHA, GIZELLA THERSA
Entity type:Individual
Prefix:MS
First Name:GIZELLA
Middle Name:THERSA
Last Name:FIRTHA
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 1:30175 VIA DEL FIERRO # 3
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-8928
Mailing Address - Country:US
Mailing Address - Phone:951-435-9728
Mailing Address - Fax:
Practice Address - Street 1:19195 US HIGHWAY 18 STE 104
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2562
Practice Address - Country:US
Practice Address - Phone:888-557-1305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-22
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician