Provider Demographics
NPI:1437485653
Name:REBECCA M. MARAVILLA, OD, INC.
Entity Type:Organization
Organization Name:REBECCA M. MARAVILLA, OD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:MARCIA
Authorized Official - Last Name:MARAVILLA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-282-2888
Mailing Address - Street 1:781 S. WEIR CANYON ROAD
Mailing Address - Street 2:SUITE 195
Mailing Address - City:ANAHEIM
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
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9041T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty