Healthcare Provider Details

I. General information

NPI: 1316576911
Provider Name (Legal Business Name): MARVEL LIONEL JULY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 04/06/2020
Certification Date: 04/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 TIERRA HUICHOL CIR
ANTHONY NM
88021-8262
US

IV. Provider business mailing address

1151 TIERRA HUICHOL CIR
ANTHONY NM
88021-8262
US

V. Phone/Fax

Practice location:
  • Phone: 714-401-1576
  • Fax:
Mailing address:
  • Phone: 714-401-1576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: