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General NPI Number Information
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NPI Number | 1174933105
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Entity Type | Individual
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Provider Name | MARA BUSH DC
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Gender | Female
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Dates
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Enumeration Date | 04/29/2014
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Last Update Date | 04/29/2014
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Provider Practice Location Address
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Address Line | 7596 EADS AVE SUITE 100
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City | LA JOLLA
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State | CA
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Zip | 92037-4851
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Country | US
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Telephone | 858-456-2663
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Fax | 858-456-9925
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Provider Business Mailing Address
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Address Line | 9066 PALOMINO RIDGE DR
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City | LAKESIDE
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State | CA
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Zip | 92040-5806
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Country | US
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Telephone | 619-938-1024
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Fax | 619-258-9738
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 11558
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License Number State | CA
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