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General NPI Number Information
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NPI Number | 1174159859
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Entity Type | Individual
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Provider Name | ALEKSANDRA MARINOVIC PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 03/13/2020
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Last Update Date | 03/13/2020
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Provider Practice Location Address
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Address Line | 391 FRONT ST STE E
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City | GROVER BEACH
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State | CA
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Zip | 93433-1984
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Country | US
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Telephone | 858-349-4496
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Fax |
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Provider Business Mailing Address
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Address Line | 1224 WOODMERE RD
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City | ORCUTT
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State | CA
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Zip | 93455-4043
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Country | US
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Telephone | 858-349-4496
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 22507
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License Number State | CA
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