Provider Demographics
NPI:1013377951
Name:BANDA, MARISELA (CADACII)
Entity Type:Individual
Prefix:MS
First Name:MARISELA
Middle Name:
Last Name:BANDA
Suffix:
Gender:F
Credentials:CADACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 E COMPTON BLVD
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90221-3401
Mailing Address - Country:US
Mailing Address - Phone:310-627-9647
Mailing Address - Fax:
Practice Address - Street 1:1315 E COMPTON BLVD
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-3401
Practice Address - Country:US
Practice Address - Phone:310-627-9647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-04
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAII2921214101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)