Provider Demographics
NPI:1255580676
Name:ZURIC, MARCIA DEESHAI (RAS)
Entity type:Individual
Prefix:MISS
First Name:MARCIA
Middle Name:DEESHAI
Last Name:ZURIC
Suffix:
Gender:F
Credentials:RAS
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:DEESHAI
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:717 LINCOLN BLVD
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291
Mailing Address - Country:US
Mailing Address - Phone:310-399-9883
Mailing Address - Fax:310-399-9678
Practice Address - Street 1:637 E ALBERTONI ST STE 200
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-1543
Practice Address - Country:US
Practice Address - Phone:310-217-0616
Practice Address - Fax:310-217-0545
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA197247Medicaid