Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003047887 |
---|---|
Provider Name | Carla Diane Brizuela |
First Address | Hacienda Heights, CA 91745-6533 |
Second Address | Irwindale, CA 91706-3752 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2009 |
Last Update Date | 21/10/2013 |