Provider Demographics
NPI:1770985491
Name:MARRUJO, ELAINA (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:ELAINA
Middle Name:
Last Name:MARRUJO
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 PARK NEWPORT
Mailing Address - Street 2:#206
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-5008
Mailing Address - Country:US
Mailing Address - Phone:949-307-6562
Mailing Address - Fax:
Practice Address - Street 1:1300 PARK NEWPORT
Practice Address - Street 2:#206
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-5008
Practice Address - Country:US
Practice Address - Phone:949-307-6562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19532235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist