Provider Demographics
NPI:1437271582
Name:MARAVILLA, REBECCA MARCIA (OD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:MARCIA
Last Name:MARAVILLA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:781 S WEIR CANYON ROAD
Mailing Address - Street 2:SUITE 195
Mailing Address - City:ANAHEIM HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92808
Mailing Address - Country:US
Mailing Address - Phone:714-282-2888
Mailing Address - Fax:714-282-2971
Practice Address - Street 1:781 S WEIR CANYON ROAD
Practice Address - Street 2:SUITE 195
Practice Address - City:ANAHEIM HILLS
Practice Address - State:CA
Practice Address - Zip Code:92808
Practice Address - Country:US
Practice Address - Phone:714-282-2888
Practice Address - Fax:714-282-2971
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9041T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U37354Medicare UPIN
CAW0P9041AMedicare ID - Type Unspecified