Healthcare Provider Details

I. General information

NPI: 1538651765
Provider Name (Legal Business Name): MARRAH D. Z. ELORZA PSY. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 10/04/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3360 N SAN FERNANDO RD # 1004
LOS ANGELES CA
90065-1417
US

IV. Provider business mailing address

3360 N SAN FERNANDO RD # 1004
LOS ANGELES CA
90065-1417
US

V. Phone/Fax

Practice location:
  • Phone: 213-479-8131
  • Fax:
Mailing address:
  • Phone: 213-479-8131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY32628
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY32628
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: