Healthcare Provider Details

I. General information

NPI: 1255580676
Provider Name (Legal Business Name): MARCIA DEESHAI ZURIC RAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARCIA DEESHAI ELLIS

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 07/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

637 E ALBERTONI ST STE 200
CARSON CA
90746-1543
US

IV. Provider business mailing address

717 LINCOLN BLVD
VENICE CA
90291
US

V. Phone/Fax

Practice location:
  • Phone: 310-217-0616
  • Fax: 310-217-0545
Mailing address:
  • Phone: 310-399-9883
  • Fax: 310-399-9678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: