Provider Demographics
NPI:1093390072
Name:SOBERON, MARINA
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:SOBERON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5060 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0728
Mailing Address - Country:US
Mailing Address - Phone:661-258-3240
Mailing Address - Fax:855-568-2494
Practice Address - Street 1:5060 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0728
Practice Address - Country:US
Practice Address - Phone:661-667-5437
Practice Address - Fax:855-568-2494
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician