Provider Demographics
NPI:1053983593
Name:GIZELLE VAZQUEZ LMFT
Entity type:Organization
Organization Name:GIZELLE VAZQUEZ LMFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT
Authorized Official - Prefix:
Authorized Official - First Name:GIZELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-631-4787
Mailing Address - Street 1:300 S BEACH BLVD STE I
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-5141
Mailing Address - Country:US
Mailing Address - Phone:562-631-4787
Mailing Address - Fax:
Practice Address - Street 1:300 S BEACH BLVD STE I
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-5141
Practice Address - Country:US
Practice Address - Phone:562-631-4787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health