Healthcare Provider Details

I. General information

NPI: 1376461665
Provider Name (Legal Business Name): LOUIS JUSTIN MARINO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29970 TECHNOLOGY DR STE 212
MURRIETA CA
92563-2649
US

IV. Provider business mailing address

40343 ARIEL HOPE WAY
MURRIETA CA
92563-4930
US

V. Phone/Fax

Practice location:
  • Phone: 951-900-4414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: