Healthcare Provider Details

I. General information

NPI: 1689189961
Provider Name (Legal Business Name): MARLEE ALEJANDRA MAGHLORIO SALAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2017
Last Update Date: 10/20/2024
Certification Date: 10/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6804 VENTURA CT
SAN BERNARDINO CA
92407-5119
US

IV. Provider business mailing address

6804 VENTURA CT
SAN BERNARDINO CA
92407-5119
US

V. Phone/Fax

Practice location:
  • Phone: 949-385-3736
  • Fax:
Mailing address:
  • Phone: 949-385-3736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number150657
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: