Provider Demographics
NPI:1174033120
Name:MAREZ, ELVIRA SYLVIA
Entity Type:Individual
Prefix:
First Name:ELVIRA
Middle Name:SYLVIA
Last Name:MAREZ
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 1:427 A ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-1975
Mailing Address - Country:US
Mailing Address - Phone:916-408-6943
Mailing Address - Fax:916-645-3311
Practice Address - Street 1:427 A ST STE 400
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-1976
Practice Address - Country:US
Practice Address - Phone:916-408-6943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-04
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51317106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist