Healthcare Provider Details

I. General information

NPI: 1427470491
Provider Name (Legal Business Name): MARINA MATHEWS CADCII
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2014
Last Update Date: 02/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 BOYD ST
YUBA CITY CA
95991-5028
US

IV. Provider business mailing address

595 BOYD ST
YUBA CITY CA
95991-5028
US

V. Phone/Fax

Practice location:
  • Phone: 530-822-7320
  • Fax: 530-822-7470
Mailing address:
  • Phone: 530-822-7320
  • Fax: 530-822-7470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberA7900612
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: