Healthcare Provider Details

I. General information

NPI: 1285548859
Provider Name (Legal Business Name): MARISSA ALMA VERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80000 AVENUE 48 SPC 116
INDIO CA
92201-6554
US

IV. Provider business mailing address

80000 AVENUE 48 SPC 116 19531 MCLANE ST, SUITE C, NORTH PALM SPRINGS, 92258
INDIO CA
92201-6554
US

V. Phone/Fax

Practice location:
  • Phone: 442-599-5939
  • Fax:
Mailing address:
  • Phone: 442-599-5939
  • Fax:

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: