MEDICARE: MRS. AMBER NICOLE MARINOFF M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	46265	CA

General Provider Information

NPI Number	:	1033132659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMBER NICOLE MARINOFF M.A.

Provider Business Mailing Address
First Line	:	1029 OLEANDER ST
Second Line	:
City	:	BREA
State	:	CA
Zip	:	92821-5240
Country	:	US
Telephone Number	:	714-255-9320
Fax Number	:

Provider Business Practice Location Address
First Line	:	1633 E 4TH ST
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92701-5163
Country	:	US
Telephone Number	:	714-565-2830
Fax Number	:	714-565-2833

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	07/08/2007

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