Provider Demographics
NPI:1063041895
Name:MARRON, JOSE LUIS I
Entity Type:Individual
Prefix:
First Name:JOSE LUIS
Middle Name:
Last Name:MARRON
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 E SANTA CLARA AVE APT 113
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-7848
Mailing Address - Country:US
Mailing Address - Phone:714-878-5398
Mailing Address - Fax:
Practice Address - Street 1:617 S HARBOR BLVD UNIT B
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-4527
Practice Address - Country:US
Practice Address - Phone:714-878-5398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty