Provider Demographics
NPI:1174760763
Name:MARON, SYLVIA MENDE
Entity type:Individual
Prefix:MRS
First Name:SYLVIA
Middle Name:MENDE
Last Name:MARON
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:SYLVIA
Other - Middle Name:
Other - Last Name:MENDE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 3315
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92067-3315
Mailing Address - Country:US
Mailing Address - Phone:858-245-9706
Mailing Address - Fax:858-759-5026
Practice Address - Street 1:1151 DOVE ST
Practice Address - Street 2:240
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2840
Practice Address - Country:US
Practice Address - Phone:858-245-9706
Practice Address - Fax:858-759-5026
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-19
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15870103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical