MEDICARE: MARLINA ROSE SELVA M.A.

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	101YM0800X	Mental Health Counselor	52478	CA

General Provider Information

NPI Number	:	1851537922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLINA ROSE SELVA M.A.

Provider Business Mailing Address
First Line	:	1307 W 6TH ST STE 109
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92882-1642
Country	:	US
Telephone Number	:	949-232-5738
Fax Number	:

Provider Business Practice Location Address
First Line	:	1307 W 6TH ST STE 109
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92882-1642
Country	:	US
Telephone Number	:	951-279-1333
Fax Number	:

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

Provider Enumeration Date	:	12/19/2008
Last Update Date	:	12/19/2008

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