Basic Information
| Provider Information | |||||||||
| NPI: | 1538627443 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAPIA-BARRERA | ||||||||
| FirstName: | MARITZA | ||||||||
| MiddleName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 15042 FRANQUETTE ST | ||||||||
| Address2: | |||||||||
| City: | LAKE ELSINORE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925306933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7143170633 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 600 CENTRAL AVE STE E1 | ||||||||
| Address2: | |||||||||
| City: | LAKE ELSINORE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925302749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9514711426 | ||||||||
| FaxNumber: | 9514711453 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2019 | ||||||||
| LastUpdateDate: | 03/25/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 12/18/2020 | ||||||||
| NPIReactivationDate: | 03/08/2021 | ||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.