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General NPI Number Information
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NPI Number | 1144731274
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Entity Type | Individual
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Provider Name | MARILYN LISA ORDORICA
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Gender | Female
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Dates
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Enumeration Date | 10/16/2017
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Last Update Date | 09/28/2022
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Provider Practice Location Address
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Address Line | 8950 VILLA LA JOLLA DR STE C121
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City | LA JOLLA
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State | CA
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Zip | 92037-1707
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Country | US
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Telephone | 877-876-3783
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Fax | 855-420-6402
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Provider Business Mailing Address
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Address Line | 8950 VILLA LA JOLLA DR STE C121
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City | LA JOLLA
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State | CA
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Zip | 92037-1707
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Country | US
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Telephone | 877-876-3783
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Fax | 855-420-6402
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 90665
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 107650
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License Number State | CA
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