Healthcare Provider Details

I. General information

NPI: 1871252072
Provider Name (Legal Business Name): MARIAN MICHEALA LITTLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2021
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3465 CAMINO DEL RIO S STE 420
SAN DIEGO CA
92108-3909
US

IV. Provider business mailing address

8755 AERO DR STE 230
SAN DIEGO CA
92123-1750
US

V. Phone/Fax

Practice location:
  • Phone: 800-974-9909
  • Fax:
Mailing address:
  • Phone: 858-256-2180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: