Provider Demographics
NPI:1376206987
Name:MARRUFO, ELENA ISABEL
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:ISABEL
Last Name:MARRUFO
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 1:552 YUCCA DR
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-4434
Mailing Address - Country:US
Mailing Address - Phone:760-562-4584
Mailing Address - Fax:
Practice Address - Street 1:552 YUCCA DR
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-4434
Practice Address - Country:US
Practice Address - Phone:760-562-4584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00000000Medicaid