Provider Demographics
NPI:1689270258
Name:MARMOLEJO, JULIANA MELISSAMARIE
Entity Type:Individual
Prefix:
First Name:JULIANA
Middle Name:MELISSAMARIE
Last Name:MARMOLEJO
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 1:1300 17TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-4504
Mailing Address - Country:US
Mailing Address - Phone:661-900-9974
Mailing Address - Fax:661-852-0206
Practice Address - Street 1:1801 19TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-4314
Practice Address - Country:US
Practice Address - Phone:661-900-9974
Practice Address - Fax:661-852-0206
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician