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General NPI Number Information
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NPI Number | 1508310996
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Entity Type | Individual
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Provider Name | JENNIFER MARAVOLA
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Gender | Female
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Dates
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Enumeration Date | 08/15/2016
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Last Update Date | 07/01/2022
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Provider Practice Location Address
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Address Line | 8600 LA MESA BLVD STE B
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City | LA MESA
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State | CA
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Zip | 91942-9572
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Country | US
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Telephone | 619-733-6414
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 HARBOR BLVD # 535
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City | OXNARD
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State | CA
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Zip | 93035-3913
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Country | US
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Telephone | 402-740-4613
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 11198
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License Number State | CA
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