Healthcare Provider Details

I. General information

NPI: 1538887344
Provider Name (Legal Business Name): MARINIA GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2022
Last Update Date: 08/17/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W 4TH ST STE B61
SANTA ANA CA
92701-4627
US

IV. Provider business mailing address

1968 S COAST HWY STE 3470
LAGUNA BEACH CA
92651-3681
US

V. Phone/Fax

Practice location:
  • Phone: 800-255-8160
  • Fax: 949-541-0042
Mailing address:
  • Phone: 800-255-8160
  • Fax: 949-541-0042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateNULL

VIII. Authorized Official

Name: SHANI MAISHA SAMBRANO
Title or Position: CEO
Credential:
Phone: 800-255-8160