Provider Demographics
NPI:1457506800
Name:MARAH, IRENE EJIOLE (NP)
Entity Type:Individual
Prefix:MS
First Name:IRENE
Middle Name:EJIOLE
Last Name:MARAH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5094 CELLINI DR
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-6123
Mailing Address - Country:US
Mailing Address - Phone:909-393-3173
Mailing Address - Fax:909-606-9322
Practice Address - Street 1:5094 CELLINI DR
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-6123
Practice Address - Country:US
Practice Address - Phone:909-393-3173
Practice Address - Fax:909-606-9322
Is Sole Proprietor?:No
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14927363L00000X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology