MEDICARE: MARIEN ULRICH EKANDZA EBALE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	AL11036H	AR

General Provider Information

NPI Number	:	1093272064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIEN ULRICH EKANDZA EBALE

Provider Business Mailing Address
First Line	:	7131 N VIA ASSISI
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-4315
Country	:	US
Telephone Number	:	520-531-2364
Fax Number	:	520-575-9794

Provider Business Practice Location Address
First Line	:	7131 N VIA ASSISI
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-4315
Country	:	US
Telephone Number	:	520-531-2364
Fax Number	:	520-575-9794

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2019
Last Update Date	:	02/26/2019

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