Provider Demographics
NPI:1538627443
Name:TAPIA-BARRERA, MARITZA
Entity type:Individual
Prefix:
First Name:MARITZA
Middle Name:
Last Name:TAPIA-BARRERA
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 1:15042 FRANQUETTE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-6933
Mailing Address - Country:US
Mailing Address - Phone:714-317-0633
Mailing Address - Fax:
Practice Address - Street 1:600 CENTRAL AVE STE E1
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-2749
Practice Address - Country:US
Practice Address - Phone:951-471-1426
Practice Address - Fax:951-471-1453
Is Sole Proprietor?:No
Enumeration Date:2019-03-10
Last Update Date:2021-03-25
Deactivation Date:2020-12-18
Deactivation Code:
Reactivation Date:2021-03-08
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health