Healthcare Provider Details

I. General information

NPI: 1588361075
Provider Name (Legal Business Name): FARIRAI MELANIA MARWIZI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2023
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 ROSS AVE
EL CENTRO CA
92243-4306
US

IV. Provider business mailing address

1415 ROSS AVE
EL CENTRO CA
92243-4306
US

V. Phone/Fax

Practice location:
  • Phone: 760-339-7100
  • Fax:
Mailing address:
  • Phone: 760-339-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number210879
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: