=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801289145
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. ZSANNA RIZZO MARBLE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2015
-----------------------------------------------------
Last Update Date | 08/16/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 38800 SKY CANYON DR STE B
-----------------------------------------------------
City | MURRIETA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92563-2540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-595-7552
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 40335 WINCHESTER RD # E292
-----------------------------------------------------
City | TEMECULA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92591-5500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-995-7552
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 100087
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------