Provider Demographics
NPI:1841466299
Name:VIZCAINO, CLARISSA PALOMA
Entity type:Individual
Prefix:MISS
First Name:CLARISSA
Middle Name:PALOMA
Last Name:VIZCAINO
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 1:4368 LOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90032-1211
Mailing Address - Country:US
Mailing Address - Phone:323-728-0100
Mailing Address - Fax:323-728-9218
Practice Address - Street 1:5723 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-4222
Practice Address - Country:US
Practice Address - Phone:323-728-0100
Practice Address - Fax:323-728-9218
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)