Provider Demographics
NPI:1609541044
Name:PINQUIAN, MARAH ISAIAH DE LATORRE (NONE)
Entity Type:Individual
Prefix:MS
First Name:MARAH ISAIAH
Middle Name:DE LATORRE
Last Name:PINQUIAN
Suffix:
Gender:F
Credentials:NONE
Other - Prefix:MS
Other - First Name:MARAH
Other - Middle Name:ISAIAH
Other - Last Name:CAUBAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NONE
Mailing Address - Street 1:18726 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-3813
Mailing Address - Country:US
Mailing Address - Phone:310-856-0800
Mailing Address - Fax:855-568-2494
Practice Address - Street 1:5060 CALIFORNIA AVE STE 610
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-7073
Practice Address - Country:US
Practice Address - Phone:661-258-3240
Practice Address - Fax:855-568-2494
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician