MEDICARE: DR. REBECCA MARCIA MARAVILLA OD

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	152W00000X	Optometrist	9041T	CA

General Provider Information

NPI Number	:	1437271582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REBECCA MARCIA MARAVILLA OD

Provider Business Mailing Address
First Line	:	781 S WEIR CANYON ROAD
Second Line	:	SUITE 195
City	:	ANAHEIM HILLS
State	:	CA
Zip	:	92808
Country	:	US
Telephone Number	:	714-282-2888
Fax Number	:	714-282-2971

Provider Business Practice Location Address
First Line	:	781 S WEIR CANYON ROAD
Second Line	:	SUITE 195
City	:	ANAHEIM HILLS
State	:	CA
Zip	:	92808
Country	:	US
Telephone Number	:	714-282-2888
Fax Number	:	714-282-2971

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

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	07/08/2007

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