MEDICARE: LAUREN ALISSA MARINERO

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	1041C0700X	Clinical Social Worker	137240	CA

General Provider Information

NPI Number	:	1780337543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN ALISSA MARINERO

Provider Business Mailing Address
First Line	:	510 S 2ND AVE
Second Line	:
City	:	COVINA
State	:	CA
Zip	:	91723-3017
Country	:	US
Telephone Number	:	626-974-8123
Fax Number	:	626-974-8198

Provider Business Practice Location Address
First Line	:	4684 ONTARIO MILLS PKWY STE 200
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91764-5151
Country	:	US
Telephone Number	:	909-321-6565
Fax Number	:

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

Provider Enumeration Date	:	02/01/2022
Last Update Date	:	06/01/2026

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