Healthcare Provider Details

I. General information

NPI: 1639808694
Provider Name (Legal Business Name): ELIZABETH MARCOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 S ANAHEIM BLVD
ANAHEIM CA
92805-6205
US

IV. Provider business mailing address

2440 PARK DR
SANTA ANA CA
92707-3125
US

V. Phone/Fax

Practice location:
  • Phone: 714-948-7641
  • Fax:
Mailing address:
  • Phone: 714-582-9626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: