Provider Demographics
NPI:1245747765
Name:VIRREY, MARLENE ADRIANNA (MED)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:ADRIANNA
Last Name:VIRREY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5080 SHOREHAM PL STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-5931
Mailing Address - Country:US
Mailing Address - Phone:858-272-2662
Mailing Address - Fax:
Practice Address - Street 1:50 W EDMONSTON DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1228
Practice Address - Country:US
Practice Address - Phone:215-872-4556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-05
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1-18-31659103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst