Healthcare Provider Details

I. General information

NPI: 1316260961
Provider Name (Legal Business Name): JAYCIE MARICH ATP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2010
Last Update Date: 04/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16321 GOTHARD ST SUITE B
HUNTINGTON BEACH CA
92647-3645
US

IV. Provider business mailing address

16321 GOTHARD ST SUITE B
HUNTINGTON BEACH CA
92647-3645
US

V. Phone/Fax

Practice location:
  • Phone: 714-596-9400
  • Fax: 714-596-9500
Mailing address:
  • Phone: 714-596-9400
  • Fax: 714-596-9500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: