Provider Demographics
NPI:1043230808
Name:MARRON, DOROTHY J (PHD)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:J
Last Name:MARRON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15525 POMERADO RD STE E4
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2427
Mailing Address - Country:US
Mailing Address - Phone:858-673-9600
Mailing Address - Fax:858-451-1104
Practice Address - Street 1:15525 POMERADO RD STE E4
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2427
Practice Address - Country:US
Practice Address - Phone:858-673-9600
Practice Address - Fax:858-451-1104
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9126103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP9126Medicare UPIN