Provider Demographics
NPI:1124587043
Name:KERRACHE, MARINA
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:KERRACHE
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 1:730 E SAN RAMON AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-7044
Mailing Address - Country:US
Mailing Address - Phone:559-375-2071
Mailing Address - Fax:
Practice Address - Street 1:730 E SAN RAMON AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7044
Practice Address - Country:US
Practice Address - Phone:559-375-2071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician