Healthcare Provider Details

I. General information

NPI: 1174033120
Provider Name (Legal Business Name): ELVIRA SYLVIA MAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2017
Last Update Date: 10/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 A ST STE 400
LINCOLN CA
95648-1976
US

IV. Provider business mailing address

427 A ST
LINCOLN CA
95648-1975
US

V. Phone/Fax

Practice location:
  • Phone: 916-408-6943
  • Fax:
Mailing address:
  • Phone: 916-408-6943
  • Fax: 916-645-3311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number51317
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: