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General NPI Number Information
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NPI Number | 1437485653
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Entity Type | Organization
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Legal Business Name | REBECCA M. MARAVILLA, OD, INC.
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Dates
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Enumeration Date | 10/22/2009
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Last Update Date | 10/22/2009
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Provider Practice Location Address
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Address Line | 781 S. WEIR CANYON ROAD SUITE 195
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City | ANAHEIM
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State | CA
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Zip | 92808
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Country | US
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Telephone | 714-282-2888
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Fax | 714-282-2971
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Provider Business Mailing Address
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Address Line | 781 S. WEIR CANYON ROAD SUITE 195
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City | ANAHEIM
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State | CA
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Zip | 92808
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Country | US
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Telephone | 714-282-2888
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Fax | 714-282-2971
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Authorized Official
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Title or Position | PRESIDENT
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Name | REBECCA MARCIA MARAVILLA
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Credential | O.D.
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Telephone | 714-282-2888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 9041T
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License Number State | CA
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