Provider Demographics
NPI:1598812190
Name:MARIN, ALICIA SOCORRO (DC)
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:SOCORRO
Last Name:MARIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10466 GARVEY AVE
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91733-2264
Mailing Address - Country:US
Mailing Address - Phone:626-433-0453
Mailing Address - Fax:626-433-0493
Practice Address - Street 1:3276 ASHGATE WAY
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-0420
Practice Address - Country:US
Practice Address - Phone:909-947-4949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24496111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC24496Medicare ID - Type Unspecified