Healthcare Provider Details

I. General information

NPI: 1205674264
Provider Name (Legal Business Name): ASHLEY HANOMI MARANAN MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 INDIANA AVE STE 170
RIVERSIDE CA
92506-4266
US

IV. Provider business mailing address

31291 VIA PARED
THOUSAND PALMS CA
92276-3395
US

V. Phone/Fax

Practice location:
  • Phone: 951-533-5263
  • Fax:
Mailing address:
  • Phone: 760-636-2256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: