Healthcare Provider Details

I. General information

NPI: 1477010254
Provider Name (Legal Business Name): MARLAYNA WULF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2019
Last Update Date: 02/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 12TH ST STE B
MARINA CA
93933-6003
US

IV. Provider business mailing address

299 12TH ST STE B
MARINA CA
93933-6003
US

V. Phone/Fax

Practice location:
  • Phone: 831-883-3030
  • Fax: 831-883-3032
Mailing address:
  • Phone: 831-883-3030
  • Fax: 831-883-3032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: