Provider Demographics
NPI:1790219145
Name:MARAVILLA, MARIELA
Entity Type:Individual
Prefix:MISS
First Name:MARIELA
Middle Name:
Last Name:MARAVILLA
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:PO BOX 5091,
Mailing Address - Street 2:6200 S. MOONEY BLVD.
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93278-5091
Mailing Address - Country:US
Mailing Address - Phone:559-747-0115
Mailing Address - Fax:559-733-6300
Practice Address - Street 1:6200 S. MOONEY BLVD.
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277
Practice Address - Country:US
Practice Address - Phone:559-733-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health