Provider Demographics
NPI:1831835057
Name:MIZANI, RESHMI LATA
Entity type:Individual
Prefix:MRS
First Name:RESHMI
Middle Name:LATA
Last Name:MIZANI
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:RESHMI
Other - Middle Name:
Other - Last Name:PRASAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:DEPTLA 22763,PASADENA CA 91185-2763
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91185-2763
Mailing Address - Country:US
Mailing Address - Phone:866-523-4268
Mailing Address - Fax:
Practice Address - Street 1:8950 CAL CENTER DR STE 137
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-3236
Practice Address - Country:US
Practice Address - Phone:855-523-4268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician