Provider Demographics
NPI:1134256613
Name:AMAYA, MARCIA GRICEL (MS)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:GRICEL
Last Name:AMAYA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1727 LORETTA LN
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-1327
Mailing Address - Country:US
Mailing Address - Phone:714-740-1035
Mailing Address - Fax:
Practice Address - Street 1:1727 LORETTA LN
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-1327
Practice Address - Country:US
Practice Address - Phone:714-740-1035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IMF51840106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABON0030OtherMIS