Provider Demographics
NPI:1457699233
Name:ARVIZU, STACY
Entity Type:Individual
Prefix:MISS
First Name:STACY
Middle Name:
Last Name:ARVIZU
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:PO BOX 460253
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92046-0253
Mailing Address - Country:US
Mailing Address - Phone:562-216-4762
Mailing Address - Fax:
Practice Address - Street 1:1835 W ORANGEWOOD AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2011
Practice Address - Country:US
Practice Address - Phone:714-939-7608
Practice Address - Fax:714-939-7630
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 72768101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health