Basic Information
| Provider Information | |||||||||
| NPI: | 1972734325 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAZARES | ||||||||
| FirstName: | DENISE | ||||||||
| MiddleName: | MICHELLE | ||||||||
| NamePrefix: | MISS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1126 N. GRAND AVENUE | ||||||||
| Address2: | STE D | ||||||||
| City: | COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6269671667 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1126 N GRAND AVE | ||||||||
| Address2: | STE D | ||||||||
| City: | COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917241551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6269671667 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2009 | ||||||||
| LastUpdateDate: | 01/26/2017 | ||||||||
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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 | 79748 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.