Healthcare Provider Details

I. General information

NPI: 1528749793
Provider Name (Legal Business Name): MARISA ELEAZAR-FRANKE DAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4452 PARK BLVD STE 204
SAN DIEGO CA
92116-4039
US

IV. Provider business mailing address

2704 LANDIS ST
SAN DIEGO CA
92104-3517
US

V. Phone/Fax

Practice location:
  • Phone: 619-823-1382
  • Fax:
Mailing address:
  • Phone: 415-308-7288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number22478
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: