Provider Demographics
NPI:1891047601
Name:ROXAS, MARVIN (AOD INTERN)
Entity Type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:
Last Name:ROXAS
Suffix:
Gender:M
Credentials:AOD INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3660 FAIRMOUNT AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105
Mailing Address - Country:US
Mailing Address - Phone:619-521-2250
Mailing Address - Fax:619-521-5944
Practice Address - Street 1:3660 FAIRMOUNT AVENUE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105
Practice Address - Country:US
Practice Address - Phone:619-521-2250
Practice Address - Fax:619-521-5944
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)