Provider Demographics
NPI:1720792229
Name:PLAZA, AZUCENA MARLEN (CRISIS SPECIALIST)
Entity Type:Individual
Prefix:
First Name:AZUCENA
Middle Name:MARLEN
Last Name:PLAZA
Suffix:
Gender:F
Credentials:CRISIS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 SUNRISE AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4106
Mailing Address - Country:US
Mailing Address - Phone:916-873-5207
Mailing Address - Fax:
Practice Address - Street 1:1133 W SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:WILLOWS
Practice Address - State:CA
Practice Address - Zip Code:95988-2601
Practice Address - Country:US
Practice Address - Phone:530-934-1832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health