Provider Demographics
NPI:1831579234
Name:SILVA, MARIANA (LPT)
Entity type:Individual
Prefix:
First Name:MARIANA
Middle Name:
Last Name:SILVA
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:MARIANA
Other - Middle Name:
Other - Last Name:ESQUIVEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8160 VICTORIA AVE APT A
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-2328
Mailing Address - Country:US
Mailing Address - Phone:909-538-0247
Mailing Address - Fax:
Practice Address - Street 1:8160 VICTORIA AVE. APT. A
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280
Practice Address - Country:US
Practice Address - Phone:909-538-0247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-02
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT37683167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician