Provider Demographics
NPI:1821800699
Name:INZUNZA, FELICIANO JOSEPH (PPS, ASC)
Entity type:Individual
Prefix:DR
First Name:FELICIANO
Middle Name:JOSEPH
Last Name:INZUNZA
Suffix:
Gender:M
Credentials:PPS, ASC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17896 MANZANITA ST
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-4924
Mailing Address - Country:US
Mailing Address - Phone:901-370-0904
Mailing Address - Fax:
Practice Address - Street 1:17896 MANZANITA ST
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-4924
Practice Address - Country:US
Practice Address - Phone:901-370-0904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230318657103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool