Healthcare Provider Details

I. General information

NPI: 1578952651
Provider Name (Legal Business Name): NATALIE MAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2015
Last Update Date: 05/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 W VISTA WAY
VISTA CA
92083-5704
US

IV. Provider business mailing address

2405 OCEANSIDE BLVD.
OCEANSIDE CA
92054
US

V. Phone/Fax

Practice location:
  • Phone: 760-940-1836
  • Fax: 760-940-1274
Mailing address:
  • Phone: 760-694-6955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCI27060319
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: