Provider Demographics
NPI:1174159859
Name:MARINOVIC, ALEKSANDRA (PSYD)
Entity type:Individual
Prefix:
First Name:ALEKSANDRA
Middle Name:
Last Name:MARINOVIC
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 WOODMERE RD
Mailing Address - Street 2:
Mailing Address - City:ORCUTT
Mailing Address - State:CA
Mailing Address - Zip Code:93455-4043
Mailing Address - Country:US
Mailing Address - Phone:858-349-4496
Mailing Address - Fax:
Practice Address - Street 1:391 FRONT ST STE E
Practice Address - Street 2:
Practice Address - City:GROVER BEACH
Practice Address - State:CA
Practice Address - Zip Code:93433-1984
Practice Address - Country:US
Practice Address - Phone:858-349-4496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-13
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22507103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical