Healthcare Provider Details

I. General information

NPI: 1215869888
Provider Name (Legal Business Name): ELIANA JIEBING MARVIZON AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CRAVEN RD
SAN MARCOS CA
92078-4201
US

IV. Provider business mailing address

3629 WESLEY ST
CULVER CITY CA
90232-2434
US

V. Phone/Fax

Practice location:
  • Phone: 858-616-5100
  • Fax:
Mailing address:
  • Phone: 310-936-9139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: