Provider Demographics
NPI:1548517436
Name:ELIZARRARAZ, MONICA
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:ELIZARRARAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3914 MURPHY CANYON RD
Mailing Address - Street 2:SUITE A170
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4491
Mailing Address - Country:US
Mailing Address - Phone:858-279-6721
Mailing Address - Fax:858-279-5440
Practice Address - Street 1:3914 MURPHY CANYON RD
Practice Address - Street 2:SUITE A170
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4491
Practice Address - Country:US
Practice Address - Phone:858-279-6721
Practice Address - Fax:858-279-5440
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA76590106H00000X
CA635101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional