Basic Information
| Provider Information | |||||||||
| NPI: | 1568061703 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FEMATT BRIZUELA | ||||||||
| FirstName: | EDITH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1982 KENT ST | ||||||||
| Address2: | |||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919132703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195198980 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1161 BAY BLVD STE B | ||||||||
| Address2: | |||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919112670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192750822 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2020 | ||||||||
| LastUpdateDate: | 11/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 8836 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.