Healthcare Provider Details

I. General information

NPI: 1538967435
Provider Name (Legal Business Name): MADISON MARIA MARASA-FERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MADISON MARIA MARASA

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6957 N FIGUEROA ST
LOS ANGELES CA
90042-1245
US

IV. Provider business mailing address

1191 HUNTINGTON DR
DUARTE CA
91010-2400
US

V. Phone/Fax

Practice location:
  • Phone: 323-443-3175
  • Fax:
Mailing address:
  • Phone: 818-269-6909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC16659
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: