Individual
BELIZA PERDOMO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
150 S 6TH ST STE C1, GROVER BEACH, CA 93433-2057
(805) 544-0815
(805) 476-1409
Mailing address
570 DIANA PL, ARROYO GRANDE, CA 93420-4103
(818) 312-6732
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LMFT101761
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7184
MEDI-CAL
CA
01
—
7368
MEDI-CAL
CA
01
—
7667
MEDI-CAL
CA
01
—
7708
MEDI-CAL
CA
Enumeration date
01/09/2014
Last updated
06/30/2020
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