Healthcare Provider Details

I. General information

NPI: 1477187037
Provider Name (Legal Business Name): MARINA DRAGOVIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2020
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19050 MALAGUERRA AVE
MORGAN HILL CA
95037-9032
US

IV. Provider business mailing address

19050 MALAGUERRA AVE
MORGAN HILL CA
95037-9032
US

V. Phone/Fax

Practice location:
  • Phone: 408-961-4641
  • Fax: 408-971-2651
Mailing address:
  • Phone: 408-961-4660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number149431
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: