Provider Demographics
NPI:1629587373
Name:MARAZONI, KAITLYN
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:MARAZONI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 E HIGHLAND AVE UNIT 1205
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5211
Mailing Address - Country:US
Mailing Address - Phone:760-681-7182
Mailing Address - Fax:
Practice Address - Street 1:2525 CAMINO DEL RIO S STE 335
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3743
Practice Address - Country:US
Practice Address - Phone:877-264-6747
Practice Address - Fax:877-539-7730
Is Sole Proprietor?:No
Enumeration Date:2017-09-26
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62605363A00000X
AZ8802363A00000X
CARBT-17-39209106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician