Basic Information
| Provider Information | |||||||||
| NPI: | 1508401092 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIZER | ||||||||
| FirstName: | CHANDA | ||||||||
| MiddleName: | DENEE | ||||||||
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| Credential: | MA, AMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3517 CAMINO DEL RIO N | ||||||||
| Address2: | SUITE 407 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6199558905 | ||||||||
| FaxNumber: | 6199558906 | ||||||||
| Practice Location | |||||||||
| Address1: | 3517 CAMINO DEL RIO N | ||||||||
| Address2: | SUITE 407 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6199558905 | ||||||||
| FaxNumber: | 6199558906 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2019 | ||||||||
| LastUpdateDate: | 11/08/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 115900 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.