Provider Demographics
NPI:1558160507
Name:HUIZAR, YAZMINE P (PHD)
Entity type:Individual
Prefix:DR
First Name:YAZMINE
Middle Name:P
Last Name:HUIZAR
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3237 TOMAHAWK ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-2315
Mailing Address - Country:US
Mailing Address - Phone:915-637-9736
Mailing Address - Fax:
Practice Address - Street 1:3237 TOMAHAWK ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-2315
Practice Address - Country:US
Practice Address - Phone:915-637-9736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40476103T00000X, 103TB0200X, 103TH0004X, 103TH0100X, 103TC0700X
CA35517103T00000X, 103TB0200X, 103TC0700X, 103TH0004X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service