Healthcare Provider Details

I. General information

NPI: 1851624654
Provider Name (Legal Business Name): NORMA MARIE MACIAS RADT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NORMA MARIE MARQUEZ

II. Dates (important events)

Enumeration Date: 09/10/2009
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 E FOOTHILL BLVD
PASADENA CA
91107-3406
US

IV. Provider business mailing address

127 S EL MOLINO AVE
PASADENA CA
91101-2510
US

V. Phone/Fax

Practice location:
  • Phone: 626-463-1021
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1507150523
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: