Provider Demographics
NPI:1770395329
Name:ISSA, MARIANA (MT-BC)
Entity type:Individual
Prefix:
First Name:MARIANA
Middle Name:
Last Name:ISSA
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 OAK CANYON CIR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35243-4808
Mailing Address - Country:US
Mailing Address - Phone:659-279-8811
Mailing Address - Fax:
Practice Address - Street 1:3440 OAK CANYON CIR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN BRK
Practice Address - State:AL
Practice Address - Zip Code:35243-4808
Practice Address - Country:US
Practice Address - Phone:659-279-8811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18728225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist